Kentucky voices: Investigate staffing, infection rates at UK hospital

Several months ago, I asked to address the board of the University of Kentucky Chandler Hospital. I have not heard back, so I thought I would write about health care transparency and possible problems at the institution.

Designing systems to give the public access to information about health care quality may be expensive but it's very important. As with data about school performance, the public has a right to know this information, and there is no better example than the UK medical center.

Despite the ongoing investment of almost a billion dollars in a new hospital, there have been recent disturbing reports from the U.S. Department of Health and Human Services Transparency Initiative.

The survey on patients' hospital experiences (www.hospitalcompare.hhs.gov) ranked the UK hospital below the Kentucky and national averages in 9 of 10 measurements. Especially disturbing, only 66 percent said they would definitely recommend the institution, and only 56 percent stated their room and bathroom were "always clean."

UK's cleanliness rating is well below the Kentucky average of 73 percent. Cleanliness is significant, as a root factor in hospital-acquired infections. For example, C. Difficile, a deadly GI superbug, is fast becoming the No.1 hospital-acquired infection in the United States. It would be expected to lurk in bathrooms, and bleach is often required as a disinfectant.

The Centers for Medicare and Medicaid Services (CMS) has also recently released billing data regarding health-care-acquired conditions for Medicare patients discharged between Oct. 1, 2008 and June 30, 2010. (Not all submitted conditions were captured by Medicare, so the data is not entirely comparable among facilities.)

Wondering how UK did on these measurements? Not well, unfortunately. UK had the highest reported rate of deadly vascular catheter infections in the state. A total of 11 were reported in Medicare patients. This is way too high a number and should be close to zero. UK also had an unacceptably high rate of falls and deep bed ulcers. These latter conditions should be zero.

Other findings from the CMS survey about UK:

■ Vascular catheter infections, 11 cases at a rate of 0.798 per 1,000 discharges.

■ Falls and trauma, 17 cases at a rate of 1.233 per 1,000 discharges.

■ Pressure ulcers, stage III and IV, four cases at a rate of 0.29 per 1,000 discharges.

Vascular catheter bloodstream infections are very worrisome since with the use of checklists and protocols, these infections can be almost totally eliminated. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, recently noted that a large project in Michigan has not only been able to produce "dramatic infection reductions" but to keep these rates down with 60 percent of hospitals maintaining a rate of zero for one year and 24 percent of hospitals maintaining a rate of zero for two years. UK is not listed as a participant in CUSP, the Comprehensive Unit-Based Safety Program, a five-step program to improve workplace culture and reduce infections in hospitals, according to an April 2011 federal report.

The patient reports of problems with cleanliness along with the reports of unacceptably high rates of falls, bed sores and vascular line infections all point to a possible staffing issue. Staffing makes up as much as 60 percent of a hospital's operating budget and is an area that is sometimes cut if an institution is under financial stress.

Increasing this concern is the recent loss of UK's Magnet Status, an award given for excellence in nursing by the American Nurses Credentialing Center, a subsidiary of the American Nurses Association. According to the Herald-Leader, one of the reported reasons for this loss was low scores on nursing sensitive indicators. These indicators include such problems as falls and pressure ulcers. As Frankfort Regional Medical Center gained the Magnet designation, UK lost it.

There is no doubt that a complete and independent investigation by the UK hospital's governing body is needed. The board should review cases of harm and place a human face on the problem, meeting with real patients in its investigation of any lapses in quality. The board should also review raw data along with national benchmarks.

Some hospital boards also back up the setting of quality milestones with financial incentives for chief executive officers.

If there are quality problems at UK, it is of paramount importance that they are corrected since not only current patients are at risk but also the quality of the training experience of our future clinicians, which can affect care for years to come.