Stanford Health Care is facing criticism regarding patient safety due to its recent poor Medicare ratings and older C. difficile infection rates. Members of the Quality team at Stanford Health Care state that they are addressing concerns by creating the Center for Advancing Patient Safety and utilizing new cleaning methods. However, some members of the Stanford community still believe that more improvements are needed.
In December 2015, Medicare announced that it was penalizing Stanford Health Care (SHC) for poor patient safety. Due to SHC’s high frequency of potentially avoidable health-related complications, Medicare is lowering its payments to them by one percent over the course of the fiscal year, ending in September 2016. The hospital-acquired conditions in the Medicare assessment include blood clots, falls and sepsis.
However, Raj Behal, the chief quality officer of SHC, claims that the rankings do not adequately address the complexity of Stanford’s patients and their needs. For example, more than half of major teaching hospitals were penalized by Medicare, compared to 22 percent of hospitals overall.
Even though the Medicare ranking system may be flawed, SHC argues that it is still continuing to improve itself with regards to patient care and safety.
“We have recently established the Center for Advancing Patient Safety with the goal of reducing preventable harm to zero, and to proactively look for ways to reduce risks before harm can occur, particularly in light of higher clinical complexity of our patients,” Behal said.
While the penalty associated with Stanford’s poor Medicare score is a one percent reduction in Medicare payments, Behal says this will not affect any programs or services provided by SHC.
However, to repair its image, SHC is now searching for ways to show the public that it still remains a world-class hospital.
“Our goal at Stanford Health Care is to deliver standard-setting patient-desired outcomes,” Behal said.
C. diff infection rates
C. difficile, or Clostridium difficile, is a bacterium found in feces that is spread by people touching infected surfaces and then touching their mouth or mucous membrane.
According to data from 2012 and 2013 released by the California Department of Public Health (CDPH), Stanford Hospital had “significantly higher” rates of hospital-onset C. diff than predicted compared to other comparable hospitals. This amounted to 13 cases of hospital-onset C. diff infections per 10,000 inpatient days in 2012 and about 14 cases per 10,000 inpatient days in 2013.
Though 13 cases may not seem like much, many nearby hospitals had lower infection rates than Stanford Hospital. El Camino Hospital’s 2012 rate was nine cases per 10,000 inpatient days, and its 2013 rate was seven cases per 10,000 days; San Francisco General Hospital’s rate was nine cases per 10,000 days. Santa Clara Valley Medical Center’s maintained even lower rates, at five cases per 10,000 inpatient days in 2013 and eight cases per 10,000 days in 2012.
These predictions were adjusted for significant risk factors, such as the type of CDI test used, affiliations with medical schools, hospital bed size and community-onset CDI in patients who are admitted. This adjustment allows for more accurate comparisons according to the CDPH.
However, Lucy Tompkins, the Lucy Becker Professor in Medicine and Microbiology and Immunology, explained that the higher rate of infections may have been due to the adoption of a new test.
“In 2012 many teaching hospitals, including Stanford, adopted a much more sensitive test (PCR) to diagnose Clostridium difficile disease,” she said. “Although a useful test for detecting disease among those who have symptoms, this test will be positive among people who are merely carrying C. diff. but don’t have an active infection. Stanford and other hospitals noted an increase in their rates after switching to this test . . . The national measure does not distinguish between these two types of patients.”
Additionally, Tompkins claims that Stanford’s performance has improved with regards to C. diff.
“We improved our performance by reducing unnecessary testing among those with low likelihood of disease, by reducing use of certain antibiotics that increase the risk of C. Diff, and continued focus on good hand hygiene and using newer, enhanced methods for cleaning the patient care environment,” she said.
Stanford community feedback
When an anonymous member of the Stanford community learned of the poor rankings of Stanford, he was shocked. He then demanded answers and improvements from SHC.
“I just want things to be safe for patients [of SHC],” he said. “Stanford students, faculty, staff, alumni, their families should be able to feel safe going to their University’s hospital. But, according to the U.S. government – using data that [SHC] itself provided – [Stanford Hospital] is one of the worst hospitals in the country in patient safety. That should not be part of President Hennessy’s legacy.”
The community member acknowledged the possibility that the majority of the Stanford community is not aware of the statistics regarding the hospital’s poor 2015 Medicare score and high C. diff infection rates from 2012-2014. He hopes that educating the community will bring about changes for the better.
“The cliché [states] that ‘light is the best disinfectant’ with respect to the problems in an institution. Shedding light on the problem will hopefully bring about some beneficial changes,” he said.
“Stanford community members can bring that about by expressing their desire for safer care at [SHC], but only if they learn the at-present disturbing facts,” he added. “A world-class university deserves a university hospital than ranks higher than the bottom quartile of hospitals nationally with respect to patient safety.”
Contact Anne-Marie Hwang at amhwang ‘at’ stanford.edu.