A nonprofit watchdog group that analyzes hospital reporting data has given Greenwood Leflore Hospital a D with regards to hospital safety, but the hospital’s administration says the report is based on old data and doesn’t reflect where the hospital is today.
The report on “Hospital Safety Grades” is issued every six months by the Leapfrog Group, a Washington D.C.-based nonprofit organization that advises employers in the purchase of health-care insurance for their employees.
The grades are based on information reported through the Centers for Medicaid and Medicare Services’ Inpatient Quality Reporting Program. Grades are issued to more than 2,600 hospitals across the country and are one of a number of ratings systems for hospitals.
In Mississippi, nine hospitals received an A rating from the group, 12 received a B, nine received a C and five received a D.
No Mississippi hospital was assigned an F, and some hospitals in the state were not included in the report, including one often cited as the Greenwood hospital’s main competitor, North Sunflower Medical Center in Ruleville. Leapfrog said the Ruleville hospital is a critical access hospital and does not report all information through the CMS system.
In 2018, the last time Greenwood Leflore Hospital was scored by Leapfrog, it also posted a D rating. In 2016 and 2017, the hospital was rated a C.
GLH administrators and hospitals in other parts of the county that received below-average scores pointed out that data used to determine the grades can be several years old. In that time in Greenwood, administrators said, the hospital has gone through significant procedure and practice changes under the direction of a new administration – including a new chief executive officer and new chief of medical staff – and at the recommendation of a consulting firm hired by the hospital.
Leapfrog bases its grades on data reported by the hospital in such areas as patient infections, problems with surgery, practices to prevent errors, safety problems, and doctors, nurses and hospital staff. The group said their grading report is done under guidance from the Johns Hopkins Armstrong Institute for Patient Safety and Quality, which determined that when compared to “A” hospitals, patients at “D” and “F” hospitals face a 92% greater risk of avoidable death.
“The time period for that, usually there is at least a two-year lag time for the results or the surveys they have done. Since then we have implemented a lot of changes to various programs,” Greenwood Leflore Hospital CEO Subho Basu said.
“The hospital is more computerized, we’re using different outside sources ... to check our statistics on how we can improve everything,” said Dr. Raymond Girnys, chief of medical staff. “And patient safety doesn’t mean slip and fall. It means improvement in infections, outcomes, morbiditys, mortalities and other things.”
GLH administrators also pointed to the smaller samplings generated by the rural hospital as possibly skewing results in comparison to larger institutions.
One area covered by the Leapfrog grade is infections with the Greenwood hospital grading below average in MRSA (resistant bacterial) infections and infections in the blood, while grading above average in C. diff infection (a sometimes fatal cause of diarrhea and colitis), infection in the urinary tract and surgical site infection after colon surgery.
“We’ve instituted a lot of things (since the data was collected),” Girnys said. “We were the first hospital in the state of Mississippi to use ultraviolet sterilization of our operating room, our wound care center. And that’s something that is done every day. That’s to prevent infection. Our joint cases, our total knee, back cases, the infection rate in our institution is better than the majority of institutions in the state. But because it’s a low sampling, it doesn’t ring the bell.”
Girnys said a recent meeting of the committee that tracks infections noted “our rates are below the national average.”
The Leapfrog grade also looks at problems with surgery, and it scored the hospital below average on serious breathing problems and blood clots.
“That’s an initiative we’ve been doing for a long time, and I think that is also sampling error because we have specific goals that we look at,” Girnys said. “We make sure that people have prophylactics, whether it’s mechanical or pharmacologic, to prevent thrombosis. A lot of people are very sick when they get here. The clots can be present before they come in. ... The numbers we have are improving dramatically. These are all initiatives we are looking at specifically.”
Leapfrog did score the hospital above average on dangerous objects being left in patients’ bodies (the hospital actually reported no instances of this), surgical wounds splitting open, death from serious treatable complications, collapsed lungs, and accidental cuts and tears.
In the area of practice to prevent errors, Leapfrog graded the hospital below average on doctors ordering medications through a computer, handwashing, communication about discharge, and staff working together to prevent errors. The hospital rated above average on communication about medicines and safe medication administration.
Girnys said the hospital has been addressing its computer systems in stages, and while the systems have been upgraded, they are not fully integrated. The hospital’s IT staff is working on making different systems talk with each other.
“All of these are part of a continuous improvement philosophy,” Basu said. “We identify and discuss the problems and some potential ways to resolve those issues.”
On general safety problems, the hospital was graded below average on dangerous bed sores and tracking and reducing risk to patients, while getting above-average scores in patient falls and injuries and air or gas bubbles in the blood.
Girnys said the hospital in the past was documenting incidents of bed sores incorrectly, which may have skewed the numbers.
“We were worse off in our documentation initially,” he said. The hospital previously had only indicated if a bed sore was present when a patient was admitted and not the level of severity of a bed sore. “In regards to a patient coming in and having it deteriorate in the hospital, that’s not happening,” he said. “It’s improving.”
The final area of the grading report covers doctors, nurses and hospital staff, and the hospital is graded below average for effective leadership to prevent errors, enough qualified nurses, specially trained doctors caring for ICU patients, communication with nurses, and responsiveness of hospital staff. It was graded above average in communication with doctors.
Basu said GLH is fully staffed as far as nurses. “Whatever it takes,” he said. “We hire (contract) nurses and pay them a lot more, but we do not compromise on patient safety. We follow the guideline of ‘Do your best.’”
As for communication, Girnys said: “As I said, this is old data. If you look at the new data, we look at it every month, and our communication is better than 90 percent. We go through this whole dashboard (for) communication data, physician and patient, discharge information, nursing communication and professional staff communication.”
Basu said the monthly meetings are ongoing, core business practices and predated any involvement with consultants.
“There are a number of systems we have gone through and improved over the last couple of years,” Girnys said. “We have quality improvement and informatics meeting every month, and that includes physician leadership, department chairs, administration and board participation. We discuss it every month.”
Greenwood Leflore Hospital may also be producing figures that would indicate a higher-than-average mortality rate for patients because of the structure of the facility, Basu said.
“The patients who come here for treatment, a lot of them are at the end stage of their lives,” he said. “Inpatient care and inpatient treatment is not the proper level of care that they need.”
“They need hospice care,” Girnys said. “They need palliative care. They don’t need inpatient hospital care.”
In hospitals in larger cities or communities with hospice facilities, such patients are sent off to affiliated hospices, and their deaths are not reflected in the mortality rates assigned to the hospitals.
The administrators also pointed out that one of the areas the hospital tracks on a monthly basis is “complications,” which include many of the same issues tracked by the Leapfrog report. The hospital’s figures for the past two years track significantly under averages reported by hospitals nationwide.
The entire Hospital Safety Grade system can be viewed online at hospitalsafetygrade.org.
•Contact Gavin Maliska at 581-7235 or gmaliska@gwcommonwealth.com.
