What we can learn from the US on hospitals

Croakey’s correspondent on all matters North American, Dr Lesley Russell, has a report below on some initiatives aimed at improving patient safety in the US that may have some useful pointers for us.

On related issues, the Wall Street Journal has an interesting article on the growing use in the US of risk calculators, to help assess surgery patients’ risk of complications, based on a patient’s personal medical history, condition and the known risks of the procedure.  Apparently, heart surgeons have been using risk calculators for several years and they are now being developed for other surgical specialties. Is this happening in Oz, I wonder?

Meanwhile, Lesley Russell reports:

“Australian health ministers have agreed on a national core set of eight ‘sentinel events’ – severely harmful incidents that occur due to a failure of hospital systems – for which all public hospitals are required to provide data.

Recently the Productivity Commission released figures for 2007-08 that showed 147 sentinel events nationwide.  Much has been made of the fact that NSW was the worst performing state with 59 events, a significant deterioration from a year earlier, when NSW was one of the best states, recording only 32 events.

In the US there’s a surprising amount of openness about health quality, both with respect to hospitals and doctors.  In the Washington area, which has an interesting mixture of world class teaching / research hospitals and hospitals which struggle to serve the indigent population, it is very easy to find out how these facilities – public and private – are performing.  You can access these government-mandated reports for the District of Columbia, Virginia, and Maryland on line, in some case with the individual hospitals clearly identified.

In Maryland, where hospitals have been required for five years to report errors that lead to death and serious harm, the state also requires hospitals to come up with plans for preventing the reported mistakes from happening again.

The Maryland hospital association made voluntary agreements with insurance companies in 2008 not to bill for eight medical errors, including transfusions that use the wrong blood type and surgery on the wrong body part. And starting in July 2009, the state commission that sets hospital rates is using a new system that ranks hospitals on how often they commit 52 specific mistakes, from preventable obstetrical complications to infections of wounds that develop after surgery. Hospitals that report the most mistakes from that list are required to bill insurers at a lower rate, while those with fewer can charge more. The total amount spent does not change, but more money flows to the hospitals with fewer errors.

The population of Maryland is 5.63 million, somewhat less than that of NSW which is 6.89 million.  So it’s interesting to see how the two states compare on some of the indicators that are required to be reported by both.  The comparison isn’t completely valid as the agreed reporting standards in each state are likely to be different and private hospitals are excluded from the NSW data set.

Maryland reports also include falls in hospital (a major problem that caused 12 deaths in 2008), deaths due to delays in treatment, physical and sexual assaults on hospital grounds, and hospital-acquired infections.

There are lessons for Australian health ministers here – how to save lives, improve health outcomes, reduce hospital stays and costs, and ensure public trust in the health system.  Take a lesson from the Maryland playbook.”

• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies  Center for Health Policy, University of Sydney/ Australian National  University and a Research Associate at the US Studies Centre, University of Sydney.  She is currently a Visiting Fellow at the Center for American Progress in Washington DC.