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Sebastian River hospital gets an improved grade

Photo: Sebastian River Medical Center - Steward’s newly installed CEO Kyle Sanders.

If hospitals are to heal patients, they must first heal themselves. That appears to be just what Sebastian River Medical Center is doing after turning an F safety grade received last spring – one of only two in the state – to a more respectable C.

The two-letter grade improvement came in the twice-yearly Leapfrog Hospital Safety Grade, issued to 2,600 hospitals and publicly posted online.

The fall grades were announced last Thursday, though they had been known to hospital executives for three weeks prior. That would explain the confidence of Steward’s newly installed CEO, Kyle Sanders, and COO, Ralph Taylor, who also serves as chief nursing officer, earlier this month when they gave a tour of a $60 million renovation at the facility.

Along with transforming the rear façade of the U.S. 1 campus into its main entrance, the project is expected to improve safety scores even further, executives said.

“This addition is the first step of modernizing the campus,” said Jeff Nicholas, vice president of Steward Health Care real estate. “And even beyond the project, we’re doing improvements generally.”

The renovation will add 90,000 square feet, with seven operating rooms, two endoscopy rooms, a bronchoscopy suite and 48 private rooms on the top two of three floors. The wing is expected to open in late 2019 or early 2020.

The addition and improvements, executives say, will have the latest hospital safety features, from handrails to infection control, throughout the new construction. By then, an even more important improvement, the August installation of Meditech 6.1 electronic health records software, will be increasingly reflected in safety scores.

Sebastian River’s data and surveys for the C grade it just received had to be submitted by July, before the new software was installed.

The F grade from last spring relied almost entirely on data that pre-dated Steward Health’s acquisition of the hospital in May 2017, occurring under the watch of Community Health Systems, which bought the hospital from Health Management Associates in 2014. While there are still numbers from as long ago as 2015 reflected in this fall’s grade, in many categories, measures reflect six months to a year of Steward management.

The Leapfrog Group, which conducts the largest hospital safety survey in the nation, analyzes data from thousands of acute-care hospitals nationwide. The letter grades, issued on a curve with surrounding hospitals, are drawn from 28 measures of medical errors, accidents, infections and injuries.

Leapfrog uses data from its own voluntary survey, as well as the Center for Medicare and Medicaid Services or CMS; the Centers for Disease Control and Prevention or CDC; the Agency for Healthcare Research and Quality; and the annual survey of the American Hospital Association. If hospitals opt not to complete a survey, Leapfrog gives the hospital a grade anyway, basing it on other data sources.

Leapfrog says its goal is to reduce the 440,000 deaths each year from hospital errors and injuries by “publicly recognizing safety and exposing harm,” according to its website.

“Many hospitals have safety records that would not be tolerated in any other industry,” the company maintains.

The difference between an A hospital and an F hospital sometimes is a matter of life and death. Leapfrog hired a patient safety and quality team at Johns Hopkins to analyze preventable deaths. It found the chances of dying at a D or F hospital are 50 percent greater than at an A hospital.

Florida’s hospitals overall ranked 19th in the nation, up from 23rd in spring. A third of the state’s hospitals got As.

Last week’s C grade from Leapfrog was a relief to Steward Health though officials are determined to bring it up even further. “We think it’s an incredible improvement, but we’re not satisfied with a C,” said Dr. Joseph Weinstein, systemwide chief medical officer for Steward Health.

Last spring’s F was one of only two in the state. It factored in a worst-in-nation score in falls and a near worst-in-nation frequency of dangerous objects left in body after surgery. The rate of bedsores deemed “dangerous” was three times the national average. Steward stressed nearly all the data was from the Community Health Systems tenure.

This time, the rate of bed sores was lower than the national average and there were no objects left in patients after surgery. Patient falls were still higher than the average, but the number was a third of what it was last spring.

“We’re always working to eliminate falls,” said Weinstein. He said measures include reducing excessive medication that can make patients drowsy, using bed and chair alarms to alert staff when a patient stands up, and making sure bed rails are raised.

Weinstein said half the score is related to quality measures, and the other half has to do with process – whether management provides adequate staffing, or how well nurses communicate with patients, for example.

He said two areas of concern in the safety grade just released have already been addressed. The rate of urinary tract infection involving catheters was high; Weinstein said the hospital is now removing catheters “as soon as they are not needed.” As for surgical site infections following colon surgery, another red-zone rate, prophylactic antibiotics are being given by IV an hour prior to surgery.

One major change at Sebastian River only took effect in August, after the Leapfrog surveys for 2018 were already submitted. That was the implementation of new electronic medical records software, Meditech 6.1, which included an upgrade of the hospital’s computerized physician order entry, or CPOE.

The new software adds a powerful safeguard against errors in prescribing medicine and other physician orders, blocking any order that conflicts with a patient’s medical history or current treatment – an allergy to a certain drug, for example. “If you were allergic to penicillin and I order ampicillin, the computer would not let me. If the physician wasn’t using that platform, there’s no safety mechanism to catch that other than the pharmacist.”

“The CPOE score will continue to improve and evolve,” said Weinstein. He compared CPOE to anti-lock brakes: you don’t see them when you buy a car, but you want them there. “We installed Meditech on Aug. 1, 2018. The data had already been submitted. It’s going to make a huge difference. We had CPOE in 2017, but it was not nearly what we have now. This is something people can’t see when they come in, but it’s absolutely essential to patient care.”

Prior to last spring’s F grade, Sebastian has had Ds and Cs since 2016.

Sebastian River Medical Center wasn’t the only local hospital to jump two letter grades. Lawnwood Regional Medical Center in Fort Pierce, an HCA-owned trauma center that takes many pediatric cases from Vero, earned an A grade in the latest Leapfrog report card. That was up from its fifth C in a row.

Lawnwood is building a freestanding emergency room on U.S. 1 in south Indian River County.

Another HCA hospital, St. Lucie Medical Center in Port St Lucie, also earned an A.

Indian River Medical Center raised its C grade to a B, its final grade before becoming a part of Cleveland Clinic Florida. Hospital spokeswoman Angela Dickens said the higher grade could be attributed to a new communication board in patient rooms; a “multidisciplinary approach to rounding” that has given caregivers more interaction with patients; and “proactive” discharge planning involving local health care organizations to get patients good care once they are home.

Ironically, Cleveland Clinic’s Weston hospital dropped from a B to a C, the only hospital in the Cleveland Clinic system to rate below a B.

Among Weston’s problem areas – infections. All five categories of infection, including MRSA and C. Difficile, were worse than the national average. Under “problems with surgery,” Leapfrog ranked Weston worse than average in surgical wounds splitting open and collapsed lungs. Patient falls were almost twice the national average. And several categories showed that Cleveland Clinic Weston “declined to report” statistics.

“We take care of the most critically ill patients with very complex surgical and medical needs and are laser focused on continued improvement in safety and reducing infection rates,” said Cleveland Clinic marketing director Evelyn Arias. “We currently do not participate in the entire Leapfrog survey.  It is but one rating system with their own methodology.”

Another soon-to-be member of the Cleveland Clinic Florida division, Martin Health, earned a B and two Cs at its three hospitals.