Officials with Tuomey Healthcare System say an in-house review of the data that led to its two-letter-grade drop in the hospital's recent Leapfrog Group Hospital Safety Scores could take several days.
However, an analysis of the various categories making up the hospital’s letter grade shows Tuomey recorded below-average results in 10 of the 28 factors considered by the survey, with these below-average performances occurring in both patient outcomes and hospital protocols.
These poor scores included issues such as Tuomey patients developing Stage 3 or 4 pressure ulcers — typically referred to as severe bed sores — at more than three times the national average, surgical patients dying at a slightly higher-than-normal rate from serious but treatable complications and a higher ratio of bloodstream infections being found in patients.
In addition, Tuomey received poor scores for having, according to the survey, inadequate staffing for both nurses and intensive care unit physicians. Within the ICU physician staffing category specifically, Tuomey received the lowest score recorded, although a majority of hospitals in South Carolina received the same low score.
Dr. Gene Dickerson, vice president of Medical Affairs for Tuomey, pointed out that in several of the categories — such as the ICU physician report — the local hospital scored poorly not because it was providing inadequate services but because Tuomey was not handling issues in the way the survey asked.
Within its report, Leapfrog indicates the only way for a hospital to score well in the ICU category would be to hire dedicated intensivists, doctors certified specifically for these departments. This is a luxury most hospitals do not have, Dickerson said.
“We don’t, nor do any hospital our size in this state, or any other state,” Dickerson said. “One thing we do provide is an advanced, or tele-ICU service, that we pay $1 million a year for, that provides 24-hours-a-day, 7-day-a-week remote intensivist coverage for all of our patients in the ICU.”
Dickerson also said while the report was still under review so that Tuomey officials could use the results to find ways to improve patient care, he did not think the single grade should be much of a reflection on the hospital.
“We’re not ashamed of this. We try to do the best we can and answer the questions the best we can. The data’s not perfect,” Dickerson said. “We never bragged on having an A. If you read my comments from the last time, I kind of downplayed it. It’s one little survey and one little measure out of several that we participate in. It’s really just a snapshot of the care that we provide.”
Six months ago, however, when Tuomey received an A for its Spring 2013 score, the hospital released a statement quoting Dickerson as saying, "As chief medical officer for Tuomey Healthcare System, I think that I can speak for the entire medical staff and administration when I say that we are very proud of achieving an 'A' grade from the Leapfrog Group. I firmly believe that this is a direct reflection on the professional attitudes and performance of our physicians, nurses, respiratory therapists, radiology technologists, nursing assistants and all of the health provider staff at our hospital and is well deserved."
The recent report is not without its high points for the local hospital. Tuomey received above-average scores in 17 of the subcategories considered, including perfect scores in seven of the 15 process-oriented categories and two of the 13 outcome-oriented categories.
Despite scoring higher than the national average in a majority of the categories, however, the end result of the recent report was a two-letter-grade drop. Of the 2,539 general hospitals issued a score, only 2.8 percent dropped by two or more grades, according to Amanda Ferraro, media specialist with Stern & Associates, the public relations firm working with Leapfrog. Survey results also indicated 32 percent of the hospitals in the report received an A, while 26 percent received a B, 35 percent a C, six percent a D and less than one percent received an F.
"We were disappointed in the result of the letter C," said Brenda Chase, spokeswoman for Tuomey Healthcare System. "We would like to take our time and go line by line through every piece of quality data that we report to see any changes that might have taken place over the last quarter that might impact the numbers. It could be a change as minuscule as .001. We absolutely know our data, but we go through thousands and thousands of lines of data and look at thousands of quality indicators. ... We feel like we do an excellent job with the safety of our patients, and this is one indicator among many. We will use this information to move forward."
Clarendon Memorial Hospital in Manning also received a C, which is an improvement from the spring score of D and even more so from the Fall 2012 score of an F.
"We're not satisfied with our current score," said Richard Stokes, CEO of Clarendon Memorial. "We're going to get better, and we are getting better. We want to incrementally, internally prepare ourselves to sustain our score. We don't want to jump up to an A to drop down to a C the next round. We are putting our internal processes in place to sustain our scores."
While he supports Leapfrog's efforts overall, Stokes does not think it is a perfect measuring system, he said.
"I think Leapfrog has some adjustments it needs to make to do smaller facilities," Stokes said. "I don't think we should be graded the same as UCLA (Ronald Reagan UCLA Medical Center.)"
For more information about the Hospital Safety Score or to view the list of state rankings, visit hospitalsafetyscore.org.