Sunday, July 11, 2010 | 2 a.m.
Do No Harm: Hospital Care in Las Vegas
- Prologue: A breakthrough in transparency
- Reporting is the first of its kind in Nevada
- Health care can hurt you
- Accident took her life, his heart
- Fall proves fatal for elderly patient
- Inadequate care, unspeakable pain
- Scarred for life by mistake in surgery
- Where I Stand: Fascination and frustration in reporting on Las Vegas hospital care
- Editorial: Preventing harm
- Health care leaders discuss Sun report’s findings
- St. Rose Dominican Hospitals to post data on quality
- State presses hospitals for full accounting of preventable injuries
Harmful events glossary
See the results
Share your stories
In response to a Las Vegas Sun investigation of hospital care, St. Rose Dominican Hospitals officials have pledged to make public their internal quality measures — and challenged other local hospitals to do the same.
The Sun investigation, based on hospital billing data on file with the state, identified 969 instances in 2008 and 2009 in which patients suffered preventable injuries, infections or other harm in Las Vegas hospitals. The information, which hospitals have fought to keep secret, holds health care providers accountable and gives patients a basis to compare where they receive care.
St. Rose CEO Rod Davis is the first hospital executive to come out in favor of greater transparency.
In a meeting last week he pledged to share with the Sun and post on his hospitals’ website cases of preventable harm — known as “adverse” events — that occur at the three St. Rose Dominican Hospitals: Siena, Rose de Lima and San Martin.
St. Rose will also publicize the so-called sentinel events it reports to the state. Sentinel events are unexpected injuries that require corrective plans. No facility in the state has ever made them public.
The decision by St. Rose marks a significant break in what has long been unified hospital opposition to public disclosure of sentinel and adverse events, including lobbying against legislation.
Davis said he decided to make the information public because of the Sun’s investigation.
“The St. Rose organization has a strong commitment to quality,” Davis said. “We believe patients who trust us with their care deserve the highest quality health care available.
“We also believe our patients and the communities we serve have a right to know how we are doing and how our results compare locally and nationally, so consumers can utilize comparative data to be better informed, and to make their own health care choices.”
Davis called executives at other hospitals in Las Vegas on Thursday, urging them to make their quality information available to the Sun and the public.
Kathy Silver, CEO of Clark County-owned University Medical Center, said she will follow St. Rose’s lead. “We will find out exactly how St. Rose plans to share the information, and we will do likewise,” Silver said.
Officials at the Valley Health and Sunrise Health systems said they will discuss the subject at a Nevada Hospital Association meeting before deciding. North Vista Hospital officials said they will discuss the issue next week.
The willingness to discuss the investigation with the Sun, and disclose the data, are an about-face for St. Rose.
Before the newspaper published its first stories in the series, on June 27, St. Rose officials refused to be interviewed. So did officials at every Las Vegas hospital except North Vista.
Instead, they allowed Bill Welch, president of the Nevada Hospital Association, the industry’s lobbying arm, to speak on their behalf.
St. Rose officials now say they regret not discussing the issues raised by the investigation.
Davis said he was initially angered by the Sun’s stories.
On July 2, he sent a letter denouncing them to every legislator in the state, saying they “grossly oversimplified hospital billing data.”
“The result was an inaccurate, incomplete and negative view of hospital care in Southern Nevada,” the letter said.
Davis said in his meeting with the Sun last week that he no longer stands behind that letter and plans to send a follow-up letter to legislators clarifying his position.
“After I went on the (Las Vegas Sun) website and really started looking at some of the stuff you’ve done, I wouldn’t say the same thing again,” Davis said. “I think the effort you all have done is worthwhile, and you particularly have done an exceptional job trying to sort through what was available.”
Davis took issue with the Sun's method for determining the rate of infections in central-line catheters, the flexible tubes inserted in a person to quickly administer medications. The Sun used the rate per hospital discharge because that is the only publicly available information.
Davis said the Sun’s numbers were accurate, but the rate-per-discharge is misleading. A more accurate measure is the rate per 1,000 central-line days, he said.
By that measure, he said, the real story can be seen: St. Rose hospitals have a low rate of central-line infections compared with other hospitals.
Davis was also upset that the Sun’s stories focused on negative aspects of hospital care because St. Rose hospitals excel in many areas.
He provided to the Sun, and will soon put on the St. Rose website, all the statistics the hospitals use to monitor quality of care. There are 53 categories that St. Rose hospitals use to monitor the care patients receive, he said. Some are publicly reported by the Centers for Medicare & Medicaid Services, the government’s insurance payer, and the Joint Commission, which accredits hospitals.
In 39 categories St. Rose-Siena meets its goal of rating in the top 25 percent nationally, and in 14 it does not. St. Rose-Rose de Lima and San Martin met the top 25 percent goal in 37 and 35 categories, respectively.
The internal quality measures for the three St. Rose hospitals will soon be posted on the hospitals’ website, along with the adverse and sentinel events, which are being compiled, Davis said.
In the aggregate, the hospitals compare well with their peers, he said. And if any measures fall short of the hospitals’ goals, “we are focusing relentlessly to improve those measures,” he said.
Leslie Johnstone, executive director of the Health Services Coalition, a group of 24 self-insured health plans covering 260,000 Nevadans, said she was “cautiously optimistic” about St. Rose’s “turnaround.” The coalition has been pushing for increased transparency since 2002, she said, and if other hospitals follow St. Rose’s lead it will be the sea change that insurance companies have sought.
“That means we don’t have to fight it out in the Legislature,” she said.
Assemblywoman Sheila Leslie, D-Reno, who has advocated for more public reporting of hospital results, said she was pleased to hear that St. Rose decided to do the “right thing.”
“I look forward to working with these hospitals on legislation to modify the sentinel events registry to make it truly transparent and useful to consumers,” Leslie said.
She said pressure from insurance companies and patients will likely force other hospitals to follow St. Rose.