Over the past several years, there has been increased attention to how hospitals manage sepsis care. All hospitals have infection control policies and procedures, yet sepsis seems to be occurring at alarming rates in some hospitals.
The Centers for Medicare & Medicaid Services (CMS) collects annual data on how well hospitals are performing in various areas. Appropriate care for sepsis is one of the areas measured. Data collected in 2017 suggested that several San Antonio hospitals were not providing proper sepsis care, including prevention and management of cases.
At Brown, Christie & Green, our San Antonio medical malpractice attorneys believe that patients deserve to know how well local hospitals perform. Before you make a decision about where to get healthcare, you should know how well hospitals manage patient safety and care. Being informed about your local healthcare facilities is one way that you can take control of your healthcare and make decisions that are best for you and your family.
In this post, we review how well San Antonio hospitals manage sepsis care based on CMS data and independent grading systems.
CMS Data on Sepsis Care in San Antonio Hospitals
Data collected by CMS is available via the datasets on Medicare.gov. This data scores hospitals on a variety of measures, including sepsis care, complication rates, timely and effective care, and various quality measures. Hospitals are scored, and that score can be compared to national benchmarks and average ratings.
CMS scores are based on a sample of patients reviewed. The score equals the percentage of those patients who received appropriate care – or care that meets quality and safety standards. For example, a score of 10 with a patient sample of 69 means that only 10 percent of those patients were receiving appropriate sepsis care at the time of the review. A low score with a high patient sample indicates a serious deviance from appropriate and acceptable standards.
San Antonio Hospitals Scored on Management of Sepsis Care
Several San Antonio hospitals scored poorly in terms of managing sepsis care. The hospitals with the lowest (i.e. worst) scores included the following:
- University Health System – Scored 13 with a patient sample of 194.
- Baptist Emergency Hospital – Scored 18 with a patient sample of 17.
- Southwest General Hospital – Scored 28 with a patient sample of 485.
- Nix Health Care System – Scored 43 with a patient sample of 114.
- Methodist Stone Oak Hospital – Scored 46 with a patient sample of 116.
- Baptist Medical Center – Scored 50 with a patient sample of 1,431.
- Christus Santa Rosa Medical Center – Scored 51 with a patient sample of 917.
- Methodist Hospital – Scored 54 with a patient sample of 155.
These San Antonio hospitals are the eight that scored the lowest in terms of overall infection care, including sepsis care. As the scores show, several patient samples were quite large, but the score remained unsettlingly low, meaning that a significant portion of patients were not receiving appropriate sepsis care at the time the data was collected.
In 2017, the national benchmark for sepsis care was 49 percent, meaning that 49 percent was the average score of hospitals across the United States. All but three of the lowest scoring hospitals in San Antonio scored below the national benchmark.
Independent Hospital Grades for San Antonio
Another way that patients can review hospital grades and scores before deciding to seek treatment there is through independent hospital grading systems, like Leapfrog Hospital Safety Grade. Leapfrog grades hospitals using standard grades of A-F. In addition to the overall grade, each hospital is graded on factors like infections, problems with surgery, safety problems, and medical errors.
For the infection grade, Leapfrog includes MRSA, C.diff, bloodstream infections, urinary tract infections (UTIs), and surgical site infections (SSIs). The best score for bloodstream infections on Leapfrog is 0.000. The worst score is 2.935. How do San Antonio hospitals compare? Consider the following:
- University Health System – University Health System received an overall grade of C. In terms of infections, the only measure that scored above the average was MRSA. University Health System scored higher than average for rates of C.diff (0.959), bloodstream infections (0.877), UTIs (1.127), and SSIs (2.383).
- Southwest General Hospital – Southwest General Hospital received an overall grade of D. Infection measures ranged, with MRSA and bloodstream infections being scored higher than average – 1.350 and 1.924 respectively. Southwest General scored lower than average for C.diff (0.475) and UTIs (0.808). Scores for SSIs were not available.
- Nix Health Care System – Nix Medical Center, specifically, received an overall grade of C. Infection scores were lower than average for MRSA (0.000) and C.diff (0.725), and were at the average for UTIs (0.875). For bloodstream infections, Nix Medical Center scored higher than average with a score of 1.647. SSI scores were not available.
- Methodist Stone Oak Hospital – Methodist Stone Oak Hospital received an overall grade of A. In terms of infection scores, Methodist Stone Oak rated lower than average for MRSA (0.000), bloodstream infections (0.206), and SSIs (0.627). It scored higher than average for C.diff (1.181) and UTIs (1.882).
- Baptist Medical Center -.Baptist Medical Center received an overall grade of B. Infection ratings ranged significantly for Baptist, with bloodstream infections scoring 0.767, almost equal to the average. Baptist Medical Center scored lower than average for C.diff (0.689), UTIs (0.782), and SSIs (0.149). It scored higher than average for MRSA infections (1.019).
- Christus Santa Rosa Medical Center – Christus Santa Rosa Medical Center received an overall grade of C, but largely scored poorly in terms of infections. Christus scored lower than average for bloodstream infections, with a score of 0.000 – the best score possible. Christus score higher than average, however, for MRSA (1.685), C.diff (0.993), UTIs (1.715), and SSIs (0.880).
- Methodist Hospital – Methodist Hospital received an overall grade of A, but was graded rather poorly in terms of infection control policies and management. Methodist Hospital was graded 0.775 for bloodstream infections. The average score is 0.789. Methodist Hospital also scored higher than average for infections MRSA (1.450), C.diff (0.962), UTIs (1.273), and SSIs (1.292).
Why Sepsis Care Benchmarks and Grading Systems are Important
In order to observe how well hospitals perform in managing sepsis care, it is important to understand how they are scored in terms of infections in general. Sepsis is a complication of infection, and can develop in anyone who has an infection, an open wound, or has medical devices inserted into their body.
Hospital patients who are most susceptible to developing sepsis are those who have IV lines inserted, those with catheters, or patients who have recently undergone surgery. Elderly patients and patients with lowered immune systems are also more vulnerable to infections and related complications.
Clinical guidelines, benchmarks, and grading systems are important for patients so they can make informed decisions about their care. Every year, sepsis affects more than 750,000 people. Mortality rates for sepsis remain high, with the average rate reaching 25-30 percent. Severe sepsis, or septic shock, increases the mortality rate to around 70 percent.
Because sepsis can be deadly, it is important that hospitals understand the risk factors and follow infection control protocols carefully.
Clinical Guidelines for Infection Control and Sepsis Care
The Centers for Disease Control and Prevention (CDC) has developed well-established guidelines for clinical practice. The CDC also works in collaboration with the Surviving Sepsis Campaign, the Society of Critical Care Medicine, and the European Society of Intensive Care medicine to consistently review and update sepsis care guidelines.
The CDC offers the “Hospital Toolkit for Adult Sepsis Surveillance”, which provides clinical data on current sepsis prevention strategies, and offers insight into early recognition and treatment programs. The Surviving Sepsis Campaign also has a document titled the “International Guidelines for Management of Severe Sepsis and Septic Shock”, which offers clinical guidelines applicable in many healthcare environments.
In addition to the guidelines established by the CDC and other regulatory agencies, most hospitals also have individualized infection control policies. So many hospitals scoring poorly on infection control and management may indicate that there is a problem with how hospitals implement and maintain these policies. Further, it may indicate problems with staffing and training.
All the best guidelines in the world can only go so far in preventing and managing infections if healthcare providers do not do their due diligence. Hospitals and healthcare providers must adhere to the standards of care when managing patients, and that includes proper infection control and management. When they fail to do so, patient lives are put at risk for devastating or even deadly complications.