From the
PRESIDENT
JOHN L. ROBERTS, MD
GLMS President | [email protected]
MAKING THE GRADE
W
e have been conditioned since
grade school to strive to get an
“A.” Our parents expected it,
and we who are parents expect it of our
children. Whenever my kids would achieve
this grade I would tell them “Reminds me
of me when I was your age!” This played
well until the day they found my old report
cards - the gig was up. I had to own the fact
that I was not always an “A” student.
Last month, Leapfrog released its fall
2016 Hospital Safety Grades. According to
its website, the Leapfrog Hospital Safety
Grade indicates how safe general acute-care
hospitals are for patients. The Safety Grade
includes data that patient safety experts use
to compare hospitals. Publicly available data
from the Centers for Medicare & Medicaid
Services (CMS), the Leapfrog Hospital Survey, and secondary data sources such as the
American Hospital Association’s Annual
Survey and the Hospital IT Supplement are
weighted and then combined to produce a
single, consumer- friendly composite score
that is published as an A, B, C, D or F letter
grade. While few people can understand
the complicated scoring system, everyone
understands that an “A” is better than a “B,”
“C” or “D.”
No hospital in the Louisville area got an
“A.”
Sick patients expect our hospitals to be
safe. A grade less than an “A” suggests that
they are not the safest they could be and
undermines our citizens’ trust in the health
care we and our hospitals provide. And our
success as physicians and hospitals depends
on that trust. Given a choice, who would not
want to go to the hospital with an “A” grade?
We as physicians and our hospitals do
not like being graded, unless of course we
get the “A.” We argue that health care is too
complicated and nuanced to be summarized
by a score or a letter. Our patients don’t
care for our excuses – they know what an
“A” is and that an “A” is better than a “B,”
“C” or “D.”
People, we all need to own this, physicians
and hospitals alike. We as physicians need
to step up and help our hospitals make the
grade. The hospitals cannot do it without
us. Indeed, several of the quality and safety
scores are directly influenced by the practice
of the physician.
For example, it has been 170 years since
Ignaz Semmelweis showed that hand washing markedly decreased mortality. Yet, our
hospitals still struggle to get physician compliance with hand hygiene.
Physicians’ orders determine when central lines and urinary catheters are placed
and when they are removed. Infections related to these devices significantly affect the
hospital’s grade.
How physicians communicate with their
patients effect patient satisfaction scores as
well as the patients’ understanding of their
disease. It is hard for the patients to be compliant with our instructions if they do not
understand their disease or the medications
we have prescribed.
Physicians rarely report adverse events or
near-miss episodes through the hospital’s
patient safety reporting mechanism. We as
physicians need to get actively involved in
this process so that we can drive improvements in our hospitals. Finally, physicians
need to take the time to get involved in root
cause analysis following adverse events so
that those events can be prevented in the
future.
A patient’s readmission to a hospital is
rarely due to the patient being discharged
too early. Rather, most often it is related
to problems in the transition of care from
inpatient to outpatient. Communication
between our hospital-based physicians and
the community physicians must improve.
Another opportunity we physicians and
our hospitals may have in the coming year
is the opportunity to change Kentucky’s laws
to allow more open discussions in our hospital safety meetings and morbidity and
mortality conferences. We have long blamed
the Democratic-controlled Kentucky House
o