Las Vegas Sun

January 18, 2018

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Health care issues

Hospitals, state leaders should find ways to improve quality of care

Over the past few months, the Las Vegas Sun’s Marshall Allen and Alex Richards have examined preventable deaths, injuries and infections that occur in Clark County’s hospitals and raised questions about the quality of care here.

The Sun has spent two years examining the issues, reviewing 2.9 million hospital billing records, and the results have been revealing. Thousands of preventable injuries have occurred, and as Allen and Richards report today in the latest part of the Sun’s investigation, there are several reasons for them. They include:

• Hospital staffing hasn’t kept pace with the demand, and poor staffing has been linked to preventable injuries. There are no mandated nurse-to-patient ratios in Nevada. The law requires hospitals to provide adequate attention to meet patients’ needs, but that can be difficult to achieve. In one hospital, each nursing assistant was required to look after the needs of 26 patients. A survey of recent UNLV nursing graduates showed more than three-quarters of the respondents said staffing levels weren’t adequate, and 65 percent said conditions were not favorable for patient safety.

• Agencies that oversee hospitals are often weak, highly influenced by the hospital industry and inconsistent. The efforts of various oversight agencies are not well coordinated. For example, one accrediting agency gave a hospital plaudits for its transplant program even though a federal review had disciplined the program for having an excessive number of deaths.

• Hospitals don’t seem to be reporting unexpected injuries, which state law requires to avoid future mistakes. The state collects information on so-called sentinel events — unexpected injuries or infections that take place in the hospitals — for that purpose, but it doesn’t seem to be working. A state investigation, spurred by the Sun’s work, revealed 342 preventable injuries in the last half of 2009, all of which appeared to fit the definition of a sentinel event. Hospitals, however, had reported just 44. Hospital officials say they are concerned about malpractice lawsuits.

Nevada needs to have an honest discussion about health care. People don’t have confidence in the system, and these facts don’t help. For years many Nevadans have trekked out of state to get care for serious health issues, and they shouldn’t have to.

The time for the discussion is ripe, particularly as the once frantic pace of growth has stopped. In the past, it has been a race to put up hospitals around the Las Vegas Valley just to meet the need. But now hospital officials, regulators and state leaders have time to consider how to improve the system.

Hospitals can start by acknowledging the problems and being more open in the ways they handle them. St. Rose Dominican Hospitals have laudably pledged to be more open with quality care information, and University Medical Center said it would follow suit. Hopefully, other hospitals will do the same.

This shouldn’t be a matter of pitting profits against patient care. Hospitals can find ways to improve the quality of care and still make a profit. Regulators and lawmakers should work with hospitals to find the best practices and the best ways to reduce preventable errors.

The bottom line is that Nevadans should be better served. It’s incumbent on everyone involved to find ways to improve the quality of care.

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