For the first time, Consumer Reports has rated U.S. hospitals for safety, combining six key measures into one composite Rating. Overall, Consumer Reports rates 1,159 hospitals in 44 states in four special regional editions of its August issue and online at www.ConsumerReports.org.
The safety score gives consumers a way to compare hospitals on patient safety. The six categories that comprise the safety score are: infections, readmissions, overuse of scanning, communication about new medications and discharge, complications, and mortality.
Infections, surgical mistakes, and other medical harm contribute to the deaths of 180,000 hospital patients a year, according to projections based on a 2010 report by the Department of Health and Human Services. And that figure only applies to Medicare patients. More than half (51 percent) of the hospitals rated by Consumer Reports received a score below 50 (on a scale of 1-100). "The safety scores provide a window into our nation's hospitals, exposing worrisome risks that are mostly preventable," said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. "A consumer who enters a hospital thinking it's a place to get better deserves to know if that is indeed the case." Some highlights:
-- Overall Safety Performance : Even the highest scoring hospitals have room for improvement. Billings Clinic in Montana was at the top of Consumer Reports' list, but it got a safety score of just 72. As noted above, 51 percent of hospitals rated by Consumer Reports earned scores below 50 on a scale of 1-100. Log on to www.ConsumerReports.org to access the Ratings in detail.
-- Deadly Infections : About one in 20 hospitalized patients will develop an infection that can be devastating, deadly even. Many can be prevented. Consumer Reports rates hospitals on surgical-site infections that develop after surgery as well as bloodstream infections caused by central-line catheters in intensive care units. Of the hospitals rated by Consumer Reports, 202 hospitals reported infections at rates higher than the national benchmark, and only 148 reported zero infections. CR gleans its data from states that require infection reporting and through the Leapfrog Group, an independent organization that tracks hospital safety and quality. Some hospitals voluntarily report central-line infection data to Leapfrog.
-- Radiation Overload : CT scans can provide essential diagnostic information. But they pose risks, too. Radiation from CT scans-which are equivalent to between 100 and 500 chest X-rays-might contribute to an estimated 29,000 future cancers a year, a 2009 study suggests. Consumer Reports' Ratings report on the percentage of chest and abdominal CT scans that are ordered twice for the same patient, once with contrast, and once without. According to one doctor interviewed for the report, probably less than 1 percent of patients undergoing chest CT scans should get double scans. Double scans of the abdomen are needed more frequently, often to define abnormalities in the liver, kidney, and pancreas. Only 28 percent of the hospitals in CR's Ratings had double-scan rates of 5 percent or less in both categories, the cutoff established by CR to determine a top Rating. Data about scanning was obtained from Hospital Compare, the online tool from the Centers for Medicare and Medicaid Services (CMS). This was also the source for scores on readmissions, mortality, and complications.
-- Readmissions : Research suggests that up to three-quarters of readmissions may be preventable. Consumer Reports includes readmissions in its safety composite score in part because the more often a patient enters a hospital, the greater the chance something will go wrong. No hospital earned CR's highest score for readmissions; 166 hospitals received CR's lowest score.
-- Communication : For Communication, again, no hospital earned CR's top score while almost 500 hospitals earned CR's lowest score forcommunication about new medications and discharge plans. The Communication scores are based on questions answered by millions of discharged patients in a federally mandated survey.
-- Some Well Known Hospitals With Less Than Outstanding Scores : Many hospitals that are well known perform poorly against Consumer Reports' new safety score, including Massachusetts General Hospital, Boston, with a safety score of 45; Ronald Reagan UCLA Medical Center, Los Angeles, 43; Cleveland Clinic, 39; New York Presbyterian, New York, 32; and Mount Sinai Medical Center, New York, 30. However, CR's safety Ratings do not assess how successful hospitals are at treating medical conditions and are not the only source that should be used to measure hospital safety and quality. The magazine report suggests other sources a consumer can investigate.
-- Medical Harm-"Probably One Of Three Leading Causes of Death" : Peter Pronovost, M.D., senior vice president for patient safety at Johns Hopkins Medicine in Baltimore, Maryland, told Consumer Reports: "Medical harm is probably one of the three leading causes of death in the U.S., but the government doesn't adequately track it as it does deaths from automobiles, plane crashes, and cancer. It's appalling." Pronovost also observes that hospitals have not given safety the attention it merits.
The CR safety score does not look comprehensively at all medical errors. As noted above, the Consumer Reports Hospital Ratings are derived from several government and independent sources. Consumer Reports used the most current data available at the time of its analysis, supplementing its Ratings by interviewing patients,physicians, hospital administrators and safety experts. The Ratings include only 18 percent of U.S. hospitals because data on patient safety still isn't reported fully and consistently nationwide. For example, only some states (far from all) require that hospitals report data for surgical-site infections, central-line infections, or both. And some hospitals voluntarily report central-line infection data to the Leapfrog Group. As a result, Consumer Reports cannot provide a safety score on every hospital. "The fact that consumers can't get a full picture of most hospitals in the U.S. underscores the need for more public reporting," said Dr. Santa.
The report outlines steps the government should take to fix the system, including the implementation of a national system for tracking and publicly reporting medical errors, as recommended by the Institute of Medicine more than 10 years ago. "The public assumes that someone keeps track of all that goes wrong, but that is just not the case," said Lisa McGiffert, director of the Safe Patient Project at Consumers Union, the advocacy arm of Consumer Reports. For more details about what needs to happen to improve hospital safety, go to www.ConsumerReports.org.