Berkshire Medical Center receives A's for patient safety

Nurses union contends Healthgrades report doesn't speak to 'facts on the ground'

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Editor's note: This article was updated on May 18, 2017, to correct the name of Joe Markman, the MNA's associate director of communications. 

PITTSFIELD — Berkshire Medical Center has received high marks for patient safety from two hospital rating services.

The hospital recently received the Healthgrades 2017 Patient Safety Excellence Award, and it also received an "A" grade in patient safety from the Leapfrog Group, a nonprofit group that monitors hospital quality and safety. The Leapfrog Group has given BMC its top rating in patient safety since those grades were first issued in 2012.

BMC Chief Quality Officer Dr. Gray Ellrodt said the Healthgrades measure signifies that BMC is in the "top 10 percent [of hospitals] in the country in providing safe care for our patients."

The 2017 Patient Safety Excellence Award places BMC among the top 10 percent of the country's safest short-term acute care, or short-term treatment, hospitals. Only 460 hospitals across the country achieved the Patient Safety Excellence Award in 2017, according to Healthgrades.

"There's somewhere around 5,000 hospitals in the U.S. and every one has to submit data to the Center for Medicaid and Medicare Services (CMS)," Ellrodt said. "That data is analyzed by Healthgrades and every other organization. You get a score based on the objective evaluation of data."

The ratings are out just as the hospital and a nurses union are in negotiations on a new contract. During this time, the Massachusetts Nursing Association has made claims that BMC's staff-to-patient ratio is inadequate and compromises patient safety. The union held a picket at the hospital in February about staffing and a handful of letters to the editor from nurses also have raised the issue.

The unionized nurses have been working under an extension of the contract that expired on Sept. 30, 2016. The union wants the new contract to include the number of patients they are expected to care for at one time.

Berkshire Health Systems, parent company of BMC, has declined to comment on the contract negotiations, but it maintains its staffing guidelines are appropriate and meet the best practices of the American Nursing Association.

The disparate points of view between the two sides is an issue that has surfaced in previous contract negotiations.

"We don't put much stock in these ratings at all," said MNA spokesman David Schildmeier. "The facts on the ground are what counts."

Based in Denver, Healthgrades Operating Co. provides information about physicians, hospitals and health care providers and has amassed information on more than 3 million U.S. health care providers.

To determine its 2017 patient safety ratings and the hospitals that received the patient safety excellence award, Healthgrades used Medicare inpatient data from the CMS to evaluate all of the country's short-term acute care hospitals in the Medicare Provider Analysis and Review File between 2013 and 2015.

The MedPAR file is the national standard file for inpatient records for all the hospitals in the U.S. Data from that file is used for 85 to 90 percent of the awards and calculations that Healthgrades compiles, according to Bill Wyatt, Healthgrades' vice president of data science.

"It's used by most other organizations, too," Wyatt said.

According to Healthgrades, the Patient Safety Excellence Award places its recipients in the top 10 percent of hospitals evaluated for their superior performance in safeguarding patients from serious, potentially preventable complications during their hospital stays. The data is evaluated through 13 "patient safety indicators" that are defined by the Agency for Healthcare Research and Quality.

During the 2013-15 study period, Healthgrades found that patients treated in hospitals that received the Patient Safety Excellence Award were, on average, 40 percent less likely to experience an accidental puncture or laceration during a procedure than patients treated at non-recipient hospitals; 44.6 percent less likely to experience a collapsed lung due to a procedure or surgery around the chest; 54.4 percent less likely to experience catheter-related bloodstream infections acquired at the hospital; and 50.2 percent less likely to experience pressure sores or bed sores acquired in the hospital.

The 2017 Patient Safety Excellence Award recipients are more than 1.6 times more likely than nonrecipients to exhibit superior outcomes in the following specialty areas: joint replacement, orthopedics, spinal surgery, cardiology and pulmonary care, according to Healthgrades.

Unionized nurses at BMC filed 321 unsafe staffing forms with hospital management between October 2015 and January 2017, according to the MNA.

The unsafe staffing forms filed by MNA nurses at BMC document times when union members claim there were not enough nurses to care for the number of patients and/or the serious of illness or injury of the patients in a staffing unit. Of those 321 reports, 280 were filed between October 2015 and October 2016 and 41 between November 2016 and January 2017. Nurses present these forms to their managers at the hospital, and MNA representatives also present them at their regular meetings with management representatives, said Joe Markman, the MNA's associate director of communications.

Management takes the forms under consideration, Markman said, but can choose not to act upon them.

"That's what they're doing so far, choosing not to do anything with it," he said.

The majority of all these unsafe staffing forms were filed outside of the 2013-2015 study period that Healthgrades used to determine the recipients of its 2017 Patient Safety Excellence Award.

Markman said the data that Healthgrades obtained from BMC came prior to the hospital's decision to cut nursing levels in seven hospital staffing grids, "which creates a real problem because they still have the same number or an increasing number of patients." He said the MNA wants the hospital to return the number of personnel in those staffing grids to 2015 levels, when they were higher than in 2016 and 2017.

Referring to other patient safety studies, Ellrodt said, "I think you have to look at who commissioned the study and who paid for the study" and that it's difficult to determine the impact of what one individual group considers to be safe.

Ellrodt said BMC staffing ratios are "not just nurse-based but team-based," and that it's "very complicated" to set the ratios for every single department. BMC's staffing ratios are based on standards set by the American Medical Association, he said, adding that the MNA "has broken with them on this issue."

"The bottom line is not the ratios but the outcomes," Ellrodt said. "Before you call a hospital unsafe, you have to look at the outcomes or the results not the ratios. Ours are outstanding."

Schildmeier said hospital ratings don't include a clear picture of what occurs in a particular hospital.

"A lot of these ratings indicators aren't first-hand accounts, and hospitals pay for it," he said.

"The MNA has said we pay for rankings, but we don't pay a dime to be ranked by any of these organizations," said BMC spokesman Michael Leary. "We do pay for their intellectual materials, but we don't pay to be ranked."

The Massachusetts Health & Hospital Association, the primary representative of the state's hospital community, actively supports transparency regarding hospital quality data and promoting better education about what that data means within the overarching goal of "informing the public," said senior director Catherine S. Bromberg in a statement.

But in the statement, Bromberg said, "improving transparency will benefit the public only if they understand and are able to use the available data. With myriad assessment measures in circulation this can be a challenge. There is concern that conflicting information between and among different rankings could result in necessary confusion for consumers.

"Massachusetts hospitals believe that the public would be best served if all organizations performing quality and/or safety assessments developed a common framework for quality measurement and evaluation."

Business Editor Tony Dobrowolski can be reached at 413 496-6224.


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