Donna Marshall would like to see each of Colorado’s 28 larger hospitals participate in her group’s effort to measure what steps are in place to insure patient safety. But for now, the executive director of the Colorado Business Group on Health is pleased that the majority of Denver hospitals are willing to share their vision for the future.
The Colorado Business Group on Health, a group that helps local employers promote cost-effective, quality medical care, joined with The Leapfrog Group, a national consortium of more than 110 public and private organizations that provide health care benefits to administer the survey. Leapfrog includes such companies as Coors Brewing Co., Qwest Communications International, General Motors and Verizon Communications.
"At the outset of this report, there were a number of individuals in the business community that got together and said ‘We’ve been working on purchasing health care for a long time ... and we’re doing our darndest to make sure we get high value, high quality health care for people.’"
Marshall said the Leapfrog survey differs from most.
"Most initiatives you find in a hospital situation will seek to change the behaviors," Marshall said. "They want to change the behaviors of individual physicians or change the way patients are managed. What’s different about Leapfrog is we’re trying to change the system of care."
Marshall said the survey was an informal internal one last year and only nine Colorado hospitals responded. This year providers were asked to respond to questions on Leapfrog’s Web site. Nineteen of 28 hospitals responded, with only Children’s Hospital and University Hospital declining to participate in Denver. Children’s Hospital said it did not receive a survey and University is undergoing staffing and technology changes that affect standards measured by the survey.
The survey focused on how hospitals did in three key areas identified by Leapfrog for reducing medical errors. The first area involved computerized physician order forms that would help nurses, pharmacy workers and others insure dosing safety. The computers could even alert hospital workers when a dosage may be too high for the patient.
The second area was evidence-based hospital referrals. In theory, hospitals that perform a larger number of certain types of procedures are more likely to have favorable outcomes.
The final area measured was the presence of critical-care doctors in intensive care units. Leapfrog contends that staffing intensive care units with physicians certified in critical-care medicine will reduce the risk of death by at least 10 percent.
The survey found that most Denver-area hospitals did not score high enough on the computerized-ordering systems and ICU staffing levels and did not have good early-stage planning efforts, meaning no clear action plan was in place for improvement.
There were exceptions. Denver Health Medical Center and HealthOne’s Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center and Swedish Medical Center all had good early efforts on the computerized-order systems.
Denver Health was also cited for using adequate levels of staffing of full-time doctors in critical care units.
Eight metro-area hospitals were recognized for meeting volume standards for at least one procedure, mostly coronary angioplasty.
Marshall conceded that it would be hard for some hospitals to achieve the volume standards simply because there aren’t enough patients to go around in a state with just four million people and multiple hospitals with different specialties.
Marshall said the number of medical errors came to the forefront in the 1999 Institute of Medicine report that showed as many as 98,000 people die each year from medical errors made in hospitals. The number is larger than the number of people who die each year from car accidents, AIDS and breast cancer.
The recent dosing error study done co-authored by University of Colorado Associate Professor Dr. Ginnie Pepper further backs that up, Marshall said. Pepper’s study found that on average Colorado hospitals commit up to 40 dosing errors per day.
"This is a clear indication things are broken," Marshall said. "I think it serves to confirm our initial concerns about the true rates of medical errors. That was my take on that."
Marshall said the lack of computerized-ordering systems in most hospitals is disappointing.
"It’s true that the hospital industry and the medical industry in general has not invested their dollars back into the information infrastructure," she said. "They put less reinvestment dollars back than the trucking industry. So it’s not really surprising that they aren’t further along, but it’s very encouraging that these are issues that are now in front of boards of trustees."
Marshall said she hopes other Colorado hospitals will participate in the group’s online survey by the end of the year.