Phoebe Putney Memorial Hospital taking steps to improve quality measures

ALBANY — While acknowledging that there were several areas in which Phoebe Putney Memorial Hospital did not do as well as its administrators would have liked on the most recent U.S. News and World Report Best Hospitals list, officials with the Albany hospital say it has several ongoing efforts in place to address areas in which it has fallen short.

The report, released last week, presented evaluations of health care facilities categorized by complex care, common care, regional hospitals and children’s hospitals.

“If you look at the information about Phoebe Putney in terms of ranking and scores, (those figures) are clearly not where we want to be,” said Dr. Steve Kitchen, chief medical officer at Phoebe. “Clearly, we feel like we can do better, and the patients deserve better.”

Phoebe was evaluated primarily based on the Best Hospitals for Common Care methodology, meant to help consumers see how the hospitals in their community stand up to close scrutiny based on data from various sources. U.S. News and World Report said this included MedPAR — a federal data set containing details of every hospital admission paid for by traditional Medicare — publicly available data points from the Centers for Medicare and Medicaid Services and measures from the 2013 American Hospital Association’s annual survey, American Nurses Credentialing Center and the Society of Thoracic Surgeons.

On the cancer scorecard, Phoebe received a 26.6 out of 100 with an “as expected” patient survival rate 30 days after admission and a moderate patient safety score. Patient volume, accounting for the number of high-risk Medicare patients from 2011-13 in a selected set of specialty-related procedures and diagnoses, for its cancer care was shown to reflect 587 discharges. A low score was received for nursing intensity, indicating that the number of nurses on staff was less than ideal.

A bright spot was the highest score for advanced technologies in cancer care, which includes image-guided radiation therapy, intensity-modulated radiation therapy, and shaped-beam radiation.

For chronic obstructive pulmonary disease (COPD), the report showed Phoebe to have an overall average rating. Survival 30 days after admission, adjusted for patient risk, was significantly worse than expected. The hospital received an as-expected rating for COPD re-admissions, the number of Medicare inpatients treated for COPD in 2010-12 was considered high with at least 364 cases, hospital-acquired infections were worse than expected, event-free admissions and patient experience were as-expected and nursing staffing was considered average.

The cardiology and heart surgery scorecard was 18.7 out of 100, with patient survival worse than expected and a moderate patient safety score. Patient volume was at a medium level with 2,871 discharges, nursing intensity was rated as low, advanced technologies were rated as medium and patient services — including programs for cardiac rehabilitation and hospice — received the highest score.

The report’s ratings for hip replacement were considered average, with re-admissions and survival thought to be as-expected and patient volume considered to be moderate. Hospital-acquired infections were worse than expected, complications were as-expected, hip revisions were significantly better than expected and survival in multiple procedures was significantly worse than expected. Nurse staffing was considered to be average and patient experience was as-expected.

For gastroenterology and gastrointestinal surgery, the report had an overall score for Phoebe of 23.5 out of 100. Survival was worse than expected, patient safety was moderate, and patient volume was considered to be high. Nursing intensity was low, but advanced technologies — such as stereotactic radiosurgery and transplant services — and patient services, such as translators and wound-management services, were found to be high.

The gynecology scorecard received an overall score of 44.1 out of 100. Survival was as expected, and patient safety was thought to be moderate. Patient volume was at the highest rating, with 104 high-risk Medicare discharges in selected specialty-related procedures from 2011-13, as was advanced technologies — which included full-field digital mammography and robotic surgery. Nursing intensity was low, and patient services — including a fertility clinic and genetic testing and counseling — were high.

For neurology and neurosurgery, the report on Phoebe had an overall score of 25.4 out of 100. Survival was worse than expected, patient safety was moderate, patient volume was high and nursing intensity was low. Advanced technologies were at the highest rating and patient services, including Alzheimer’s and hospice, were considered to be high.

The pulmonology scorecard had an overall score of 23.7 out of 100. Survival was much worse than expected, patient safety was at a moderate level and patient volume was found to be at the highest level. Nursing intensity was low, but advanced technologies — including multislice spiral computed tomography and transplant services — and patient services, such as infection isolation rooms and palliative care, were high.

The urology scorecard from the report from Phoebe was at 33.6 out of 100 with survival as-expected. Patient safety was found to be moderate, and patient volume and nursing intensity were both low. Advanced technologies was at the highest score, and patient services received a high score.

Kitchen, while not too surprised by the scores, said there are a number of initiatives in place to improve on those figures.

“I look at those and I say, ‘What are we going to do to get better?’” Kitchen said.

Kitchen said one of the improvement methods has been the formation of a Patient Safety and Quality of Care subcommittee of the hospital board, which he chairs, that includes representation from other physicians. One of the things that has been examined, he said, is best quality measures — including mortality.

“We can determine the observed versus expected ratio on mortality,” he said. “We’ve looked at heart attacks, heart failure and pneumonia, and our observed-to-expected ratio is higher. We’ve got teams looking at that to see how we can improve.”

Over the last year, staffing levels have changed in critical care, allowing for what Kitchen referred to as a “high intensity staffing model” that should be able to reduce mortality up to 40 percent. He added that steps have been taken in recent years to reduce the “door to balloon time” once a heart attack is recognized in order to resolve the blockage, ultimately leading to a better outcome.

Regarding hospital-associated infections, Kitchen said hand hygiene initiatives are under way to ensure the proper sanitation measures are used to prevent those infections, and steps are being taken to see that the potential sources are not utilized more often than they should be.

One such example that Phoebe has had an issue with is urinary catheter infections, Kitchen said.

“(The protocol encouraged now) is not putting it in unless they need one and taking it out quickly,” the chief medical officer said. “Hopefully the newer numbers will show that they (infections) have gone down.”

Central line associated infections can be caused by central lines being left in too long, which is why similar methods are being used prevent those infections. Ultraviolet cleaning pods from Surfacide were brought in earlier this year to help eliminate superbugs in vulnerable areas such as intensive care units, he added.

Meanwhile, the National Surgical Quality Improvement Program, or NSQIP, has been brought in to Phoebe in recent years to help reduce complications, deaths and costs of care associated with surgery. It is a program in which the top 10 percent of the nation’s hospitals participate, and one with which all the Phoebe surgical colleagues have been brought on board.

“The thing that is impressing me the most is that the hospitals who participate (are shown where they stand) to improve quality performance,” Kitchen said.

Efforts also are ongoing, for which Phoebe’s staff are actively being trained in, to help eliminate waste and remove system defects to make things more efficient, he said.

“The most important thing we are charged with is keeping patients safe and keeping them from preventable harm,” Kitchen said. Patient safety “is a culture, a state of mind. It is a culture very much implemented at Phoebe (that is) on everyone’s mind, that everyone (is committed to) and empowers everyone to speak up.”

The senior leadership has been involved, Kitchen said, by going onto the floors to communicate with the health care providers about concerns they may have.

“(We want to) make sure they have the resources to keep patients safe and that nobody is intimidated to speak up if they have a patient safety concern,” he said.

For more information on the hospital rankings, visit health.usnews.com.