Hospital Measures. Region 3. Twin Cities Metro: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington

Transcription

1 Regio 3 Hospital Measures Twi Cities Metro: Aoka, Carver, Dakota, Heepi, Ramsey, Scott, Washigto 48 Hospital Measures November Health Care Quality Report

2 Hospital Measures Quality of Care for Heart Coditios...51 Table of Results...59 Quality of Care for Surgeries...61 Table of Results...66 Quality of care for medical Complicatios ad Ifectios...68 Table of Results...76 Quality of Care for Other Coditios...78 Table of Results...86 Choose the health care quality topic you wat to lear about. Hospital quality iformatio is available for four topics: Heart Coditios Surgeries Medical Complicatios ad Ifectios Other Coditios Oe topic may be of greater iterest to you tha others. For example, if you or a loved oe has a heart problem, you will probably be iterested i the Heart Coditios topic. However, ayoe facig a hospital stay should be iterested i the topic Medical Complicatios ad Ifectios i the Hospital sice it discusses problems that ca occur for ay hospital patiet. All the iformatio refers to care provided for adult patiets. November Health Care Quality Report Hospital Measures 49

3 Each topic icludes iformatio o several differet quality idicators. A quality idicator is a piece of iformatio, usually a percetage rate, that shows how ofte patiets had a particular experiece whe they received medical care. These experieces reflect a particular aspect of health care quality. Each health topic is briefly described below, with examples of quality idicators for that topic. To lear about all the idicators preseted for each topic, please tur to the appropriate page oted i the idex at the start of this sectio. Heart Coditios: This sectio icludes measures related to whether patiets received the best type of care for heart attacks ad heart failure. Surgeries: This sectio icludes iformatio associated with heart surgeries ad surgery to repair a abormally elarged artery supplyig blood to the lower half of the body. There is also iformatio regardig surgery-related complicatios ad treatmets. Medical Complicatios ad Ifectios i the Hospital for Adult Patiets: This sectio icludes problems or complicatios that ca be experieced by ay hospital patiet, as well as ifectio prevetio measures. Other Coditios: This sectio icludes iformatio about the best types of treatmet for peumoia patiets, ad problems related to hip fracture surgeries, ad childbirth, specifically how ofte a birthrelated ijury occurs to the mother. More Iformatio about the Results Be sure to ote whether a or lower percetage rate is better for the measure you are iterested i. This will vary across the differet measures for hospitals. Keep i mid the percetage rate is related to how may patiets out of oe hudred met the criteria outlied i the measure. For example, if the hospital rate for the Heart Attack: Aspiri Give Whe Patiets Arrived at the Hospital measure is 88%, this meas 88 out of 100 heart attack patiets received aspiri whe they arrived at the hospital. 50 Quality Health Care Measures November Health Care Quality Report

4 Quality of Care for Heart Coditios Sectio CONTENTS Quality of Care for Heart Attacks The Best Care for Heart Attack Patiets Aspiri Give Whe Patiets Arrived at the Hospital...52 Aspiri Prescribed Whe Patiets were Released from the Hospital Patiets Give ACE Ihibitor or ARB Prescriptio for Left Vetricular Systolic Dysfuctio (LVSD) Whe Released from the Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Patiets Give Beta Blocker Prescriptio Whe Released from the Hospital...54 Patiets Give Fibriolytic Medicatio Withi 30 Miutes of Hospital Arrival...55 Patiets Give PCI Withi 90 Miutes of Hospital Arrival...55 Table of Results...59 Appedix Table Quality of Care for Heart Failure The Best Care for Heart Failure Patiets...56 Patiets Give Istructios Whe Released from the Hospital...57 Patiets Give Evaluatio of Left Vetricular Systolic (LVS) Fuctio While i the Hospital or Scheduled for After the Patiet was Released Patiets Give ACE Ihibitor or ARB Prescriptio for Left Vetricular Systolic Dysfuctio (LVSD) Whe Released from the Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Table of Results...59 Quality of Care for Heart Coditios Heart attacks A heart attack (also called acute myocardial ifarctio or AMI) happes whe the arteries leadig to the heart become blocked ad the blood supply is slowed or stopped. Whe the heart muscle ca t get the oxyge ad utriets it eeds, the part of the heart tissue that is affected may die. The symptoms of a heart attack ca iclude: chest pai (ofte described as a crushig, squeezig or burig pai i the ceter of the chest that may radiate to your arm or jaw) shortess of breath dizziess or faitess sweatig ausea cold or clammy ski a gray or very ill appearace. Sometimes there may be o symptoms, especially if you have diabetes. Wome sometimes have differet symptoms, such as a differet kid of chest pai ad/or abdomial pai. Appedix Table November Health Care Quality Report Hospital Measures 51

5 The Best Care for Heart Attack Patiets This measure shows the percet of patiets receivig ALL of the appropriate care that they should have received based o their cliical coditio. For heart attack patiets this icludes the remaiig measures i this sectio: Aspiri Give Whe Patiets Arrive at the Hospital Aspiri Give Whe Patiets were Released from the Hospital Patiets Give ACE Ihibitor or ARB Prescriptio for left vetricular systolic dysfuctio (LVSD) Whe Released from the Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Patiets Give Beta Blocker Prescriptio Whe Released from the Hospital Patiets Give Fibriolytic Medicatio Withi 30 Miutes of Hospital Arrival Patiets Give PCI Withi 90 Miutes of Hospital Arrival The measure takes patiet idividuality ito cosideratio, lookig at oe patiet ad his/her episode of care at a time, related to heart attacks (also kow as acute myocardial ifarctio or AMI). Why is this importat? This measure is a composite, or all-or-oe, quality of care measure called a appropriate care measure (ACM). These types of Whe choosig a measures are patiet-focused measures that provide a way of lookig at whether a patiet rate. received ALL of the appropriate or right care (recommeded treatmets) that he or she should have received, based o his or her cliical coditio. Heart Attack: Aspiri Give Whe Patiets Arrived at the Hospital This measure shows the percet of heart attack patiets who were give (or took) aspiri withi 24 hours of arrival at the hospital. Why is this importat? The heart is a muscle that gets oxyge through blood vessels. Sometimes blood clots ca block these blood vessels, ad the heart ca t get eough oxyge. This ca cause a heart attack (also kow as a acute myocardial ifarctio or AMI). Chewig a aspiri as soo as symptoms of a heart attack begi may help reduce the severity of the attack. This chart shows the percet of heart attack patiets who were give (or took) aspiri withi 24 hours of arrival at the hospital. Performace o this measure raged from 93 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (AMI-1: Aspiri at arrival) Whe choosig a rate. Performace o this measure raged from 88 percet to 100 percet. MEASURE SOURCE: Acute Myorcardial Ifarctio Appropriate Care Measure (AMI-ACM) 52 Hospital Measures November Health Care Quality Report

6 Heart Attack: Aspiri Prescribed Whe Patiets were Released from the Hospital This measure shows the percet of heart attack patiets who were prescribed aspiri whe they were discharged from the hospital. Why is this importat? Blood clots ca block blood vessels. Aspiri ca help prevet blood clots from formig or help dissolve blood clots that have formed. Followig a heart attack, cotiued use of aspiri may help reduce the risk of aother heart attack. Aspiri ca have side effects like stomach iflammatio, bleedig, or allergic reactios. Talk to your health care provider before usig aspiri o a regular basis to make sure it s safe for you. Performace o this measure raged from 95 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (AMI-2: Aspiri prescribed at discharge) Whe choosig a rate. Heart Attack: Patiets Give ACE Ihibitor or ARB Prescriptio for Left Vetricular Systolic Dysfuctio (LVSD) Whe Released from the Hospital This measure is used to assess the percet of heart attack patiets with left vetricular systolic dysfuctio (LVSD) who were prescribed a ACE Ihibitor or ARB whe they were discharged from the hospital. For purposes of this measure, LVSD is defied as chart documetatio of a left vetricular ejectio fractio (LVEF) less tha 40% or a arrative descriptio of left vetricular systolic (LVS) fuctio cosistet with moderate or severe systolic dysfuctio. Why is this importat? ACE (agiotesi covertig ezyme) ihibitors Whe choosig a ad ARBs (agiotesi receptor blockers) are medicies used to treat patiets with heart failure ad are particularly beeficial i those patiets rate. with heart failure ad decreased fuctio of the left side of the heart. Early treatmet with ACE ihibitors ad ARBs i patiets who have heart failure symptoms or decreased heart fuctio after a heart attack ca also reduce their risk of death from future heart attacks. ACE ihibitors ad ARBs work by limitig the effects of a hormoe that arrows blood vessels, ad may thus lower blood pressure ad reduce the work the heart has to perform. Sice the ways i which these two kids of drugs work are differet, your doctor will decide which drug is most appropriate for you. If you have a heart attack ad/or heart failure, you should get a prescriptio for ACE ihibitors or ARBs if you have decreased heart fuctio before you leave the hospital. Performace o this measure raged from 96 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (AMI-3: ACEI or ARB for Left Vetricular Systolic Dysfuctio (LVSD)) November Health Care Quality Report Hospital Measures 53

7 Heart Attack: Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital This measure shows the percet of heart attack patiets with a history of smokig cigarettes, who were give advice/couselig about stoppig smokig while they were i the hospital. For the purposes of this measure, a smoker is defied as someoe who has smoked cigarettes aytime durig the year prior to hospital arrival. Whe choosig a rate. Why is this importat? Smokig icreases your risk for developig blood clots ad heart disease that ca result i a heart attack, heart failure or stroke. Smokig causes your arteries to thicke ad your blood vessels to arrow. Fat ad plaque stick to the walls of your arteries, which makes it harder for blood to flow. Reduced blood flow to your heart may result i chest pai, high blood pressure, ad a icreased heart rate. Smokig is also liked to lug disease ad cacer, ad ca cause premature death. It is importat that you get iformatio to help you quit smokig before you leave the hospital. Quittig may help prevet aother heart attack. Heart Attack: Patiets Give Beta Blocker Prescriptio Whe Released from the Hospital This measure shows the percet of heart attack patiets who were prescribed a beta-blocker whe they were discharged from the hospital. Why is this importat? Beta blockers are a type of medicie that is used to lower blood pressure, treat chest pai (agia) ad heart failure, ad to help prevet a heart attack. Beta blockers relieve the stress o your heart by slowig the heart rate ad reducig the force with which your heart muscles cotract to pump blood. They also help keep blood vessels from costrictig i your heart, brai, ad body. If you have a heart attack, you should get a prescriptio for a beta blocker before you leave the hospital. Performace o this measure raged from 93 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (AMI-5: Beta-blocker prescribed at discharge) Whe choosig a rate. Performace o this measure raged from 99 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (AMI-4: Adult smokig cessatio advice/couselig) 54 Hospital Measures November Health Care Quality Report

8 Heart Attack: Patiets Give Fibriolytic Medicatio Withi 30 Miutes of Hospital Arrival This measure shows the percet of heart attack patiets receivig fibriolytic therapy durig the hospital stay ad havig a time from hospital arrival to fibriolysis of 30 miutes or less. Whe choosig a rate. Why is this importat? The heart is a muscle that gets oxyge through blood vessels. Sometimes blood clots ca block these blood vessels ad the heart ca t get eough oxyge. This ca cause a heart attack. Fibriolytic drugs are medicies that ca help dissolve blood clots i blood vessels ad improve blood flow to your heart. You should get them withi 30 miutes of arrival at the hospital. MEASURE source: Hospital Compare Measure (AMI-7a: Fibriolytic therapy received withi 30 miutes of hospital arrival) Heart Attack: Patiets Give PCI Withi 90 Miutes of Hospital Arrival This measure shows the percetage of heart attack patiets receivig primary Percutaeous Coroary Itervetio (PCI) durig the hospital stay. For the purposes of this measure, the PCI was received withi 90 miutes or less from the time the patiet arrived at the hospital. Why is this importat? The heart is a muscle that gets oxyge through blood vessels. Sometimes blood clots ca block these blood vessels, ad the heart ca t get eough oxyge. This ca cause a heart attack. Percutaeous Coroary Itervetios (PCI) are procedures that are Whe choosig a rate. amog the most effective ways to ope blocked blood vessels ad help prevet further heart muscle damage. A PCI is performed by a doctor to ope the blockage ad icrease blood flow i blocked blood vessels. Improvig blood flow to your heart as quickly as possible lesses the damage to your heart muscle. It also ca icrease your chaces of survivig a heart attack. There are three procedures commoly described by the term PCI. These procedures all ivolve a catheter (a flexible tube) that is iserted, ofte through your leg, ad guided through the blood vessels to the blockage. The three procedures are: Agioplasty - a balloo is iflated to ope the blood vessel. Stetig - a small wire tube called a stet is placed i the blood vessel to hold it ope. Atherectomy - a blade or laser cuts through ad removes the blockage. Performace o this measure raged from 87 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (AMI-8a: Primary percutaeous coroary itervetio (PCI) received withi 90 miutes of hospital arrival) November Health Care Quality Report Hospital Measures 55

9 Heart failure Heart Failure is a weakeig of the heart s pumpig power. With heart failure, your body does t get eough oxyge ad utriets to meet its eeds. Your heart tries to pump more blood, but the muscle walls become weaker over time. Symptoms of heart failure may iclude: shortess of breath from fluid i the lugs swellig (such as i legs, akles or abdome) dizziess fatigue weakess cold or clammy ski a rapid or irregular heartbeat. Heart failure ca be a result of heart coditio due to hardeig of the arteries, also kow as coroary artery disease, a heart attack, cardiomyopathy (heart muscle damage from ifectio or alcohol or drug abuse), or a overworked heart (caused over time by coditios like high blood pressure, kidey disease, diabetes, or a defect from birth). The Best Care for Heart Failure Patiets This measure shows the percet of patiets receivig ALL of the appropriate care that they should have received based o their cliical coditio. For heart failure patiets this icludes the remaiig measures i this sectio: Patiets Give Istructios Whe Released from the Hospital Patiets Give Evaluatio of Left Vetricular Systolic (LVS) Fuctio While i the Hospital or Scheduled for After the Patiet was Released Patiets Give ACE Ihibitor or ARB Prescriptio for Left Vetricular Systolic Dysfuctio (LVSD) Whe Released from the Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital The measure takes patiet idividuality ito cosideratio, lookig at oe patiet ad their episode of care at a time, related to heart failure. Why is this importat? This measure is a composite, or all-oroe, quality of care measure called a appropriate care measure (ACM). These types of measures are patietfocused measures that provide a way of lookig at whether a patiet received ALL Whe choosig a rate. of the appropriate or right care (recommeded treatmets) that he or she should have received, based o his or her cliical coditio. Each patiet is uique ad may ot be eligible for every type of care for a coditio. The measure takes this ito cosideratio. Performace o this measure raged from 26 percet to 98 percet. MEASURE SOURCE: Heart Failure Appropriate Care Measure (HF-ACM) 56 Hospital Measures November Health Care Quality Report

10 Heart Failure: Patiets Give Istructios Whe Released from the Hospital This measure shows the percet of heart failure patiets give writte discharge istructios or educatioal materials whe they were discharged from the hospital. Why is this importat? Heart failure is a chroic coditio. Whe choosig a It results i symptoms such as shortess of breath, dizziess, ad fatigue. Before you leave the hospital, the staff rate. at the hospital should provide you with iformatio to help you maage the symptoms after you get home. The iformatio should iclude: activity level (what you ca ad ca t do) diet (what you should, ad should t eat or drik) medicatios follow-up appoitmet watchig your daily weight what to do if your symptoms get worse Performace o this measure raged from 50 percet to 100 percet. Heart Failure: Patiets Give Evaluatio of Left Vetricular Systolic (LVS) Fuctio While i the Hospital or Scheduled for After the Patiet was Released This measure shows the percet of heart failure patiets with documetatio i the hospital record that left vetricular systolic (LVS) fuctio was evaluated before arrival, durig hospitalizatio, or is plaed for after discharge. Why is this importat? The proper treatmet for heart failure depeds o what area of your heart is affected. A importat test is to check how your heart is pumpig, called a evaluatio of the left vetricular systolic fuctio. It ca tell your health care provider whether the left side of your heart is pumpig properly. Performace o this measure raged from 70 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (HF-2: Evaluatio of left vetricular systolic (LVS) fuctio) Whe choosig a rate. MEASURE SOURCE: Hospital Compare Measure (HF-1: Discharge istructios) November Health Care Quality Report Hospital Measures 57

11 Heart Failure: Patiets Give ACE Ihibitor or ARB Prescriptio for Left Vetricular Systolic Dysfuctio (LVSD) Whe Released from the Hospital This measure shows the percet of heart failure patiets with left vetricular systolic dysfuctio (LVSD) who are prescribed a ACEI or ARB at hospital discharge. For purposes of this measure, LVSD is defied as chart documetatio of a left vetricular ejectio fractio (LVEF) less tha 40% or a arrative descriptio of left vetricular systolic (LVS) fuctio cosistet with moderate or severe systolic dysfuctio. Why is this importat? ACE (agiotesi covertig ezyme) ihibitors ad ARBs (agiotesi receptor blockers) Whe choosig a are medicies used to treat patiets with heart failure ad are particularly beeficial i rate. those patiets with heart failure ad decreased fuctio of the left side of the heart. Early treatmet with ACE ihibitors ad ARBs i patiets who have heart failure symptoms or decreased heart fuctio after a heart attack ca also reduce their risk of death from future heart attacks. ACE ihibitors ad ARBs work by limitig the effects of a hormoe that arrows blood vessels, ad may thus lower blood pressure ad reduce the work the heart has to perform. Sice the ways i which these two kids of drugs work are differet, your doctor will decide which drug is most appropriate for you. If you have a heart attack ad/or heart failure, you should get a prescriptio for ACE ihibitors or ARBs if you have decreased heart fuctio before you leave the hospital. Heart Failure: Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital This measure shows the umber of heart failure patiets with a history of smokig cigarettes, who are give advice or couselig about stoppig smokig while i the hospital. For the purposes of the measure, a smoker is defied as someoe who has smoked cigarettes aytime durig the year prior to hospital arrival. Why is this importat? Smokig icreases your risk for developig blood clots ad heart disease, which ca result i a heart attack, heart failure or stroke. Smokig causes your blood vessels to thicke. Fat ad plaque the stick to the wall of your blood vessels, which makes it harder for blood to flow. Reduced blood flow to your heart may result i chest pai, high blood pressure, ad a icreased heart rate. Smokig is liked to lug disease ad cacer, ad ca cause premature death. It is importat for your health that you get iformatio to help you quit smokig before you leave the hospital. Performace o this measure raged from 96 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (HF-4: Adult smokig cessatio advice/couselig) Whe choosig a rate. Performace o this measure raged from 81 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (HF-3: ACEI or ARB for left vetricular systolic dysfuctio (LVSD)) 58 Hospital Measures November Health Care Quality Report

12 Quality of Care for Heart Coditios Whe choosig a hospital, please check to see if the or lower rate. Note o Percetage Rates: The rate shows how may patiets out of oe hudred received the described treatmet. HOSPITAL NAME The Best Care for Heart Attack Patiets Aspiri Give Whe Patiets Arrived at the Hospital Aspiri Prescribed Whe Patiets were Released from the Hospital Heart Attack Patiets Give ACE Ihibitor or ARB Prescriptio for LVSD Whe Released from Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Patiets Give Beta Blocker Prescriptio Whe Released from the Hospital Patiets Give Fibriolytic Medicatio Withi 30 Miutes of Hospital Arrival Patiets Give PCI Withi 90 Miutes of Hospital Arrival The Best Care for Heart Failure Patiets Patiets Give Istructios Whe Released from the Hospital Heart Failure Patiets Give Evaluatio of LVS Fuctio While i the Hospital or Scheduled for After the Patiet was Released Patiets Give ACE Ihibitor or ARB Prescriptio for LVSD Whe Released from the Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Overall Miesota Average Abbott Northwester Hospital - Mieapolis Childre s Hospitals ad Cliics - Mieapolis Childre s Hospitals ad Cliics - St. Paul Fairview Ridges Hospital - Bursville Fairview Southdale Hospital - Edia Gillette Childre s Specialty Healthcare - St. Paul Heepi Couty Medical Ceter - Mieapolis Lakeview Memorial Hospital - Stillwater Maple Grove Hospital Mercy Hospital - Coo Rapids North Memorial Health Care - Robbisdale Northfield Hospital Park Nicollet Methodist Hospital - St. Louis Park 97% 95% 93% 94% 90% 90% * 94% 83% 70% 83% 86% 83% 99% 100% 100% 98% 100% 100% * 100% 92% 92% 100% 98% 100% * * * * * * * * * * * * * * * * * * * * * * * * * * 91% 100% 95% * * 93% * * 91% 92% 98% 98% * 98% 99% 99% 99% 100% 100% * 96% 90% 89% 99% 95% 100% * * * * * * * * * * * * * 97% 100% 99% 100% 100% 100% * 88% 90% 88% 100% 100% 100% * * * * * * * * 92% 93% 97% * * * * * * * * * * * * * * * 98% 99% 100% 100% 100% 99% * 96% 93% 93% 100% 99% 100% 97% 99% 100% 97% 100% 99% * 98% 85% 84% 98% 96% 96% * * * * * * * * 69% 62% 98% * * 97% 100% 99% 100% 100% 98% * 95% 92% 91% 99% 98% 100% * Sufficiet data ot available For more detailed iformatio, see appedices startig o page 259. November Health Care Quality Report Hospital Measures 59

13 Quality of Care for Heart Coditios Whe choosig a hospital, please check to see if the or lower rate. Note o Percetage Rates: The rate shows how may patiets out of oe hudred received the described treatmet. HOSPITAL NAME The Best Care for Heart Attack Patiets Aspiri Give Whe Patiets Arrived at the Hospital Aspiri Prescribed Whe Patiets were Released from the Hospital Heart Attack Patiets Give ACE Ihibitor or ARB Prescriptio for LVSD Whe Released from Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Patiets Give Beta Blocker Prescriptio Whe Released from the Hospital Patiets Give Fibriolytic Medicatio Withi 30 Miutes of Hospital Arrival Patiets Give PCI Withi 90 Miutes of Hospital Arrival The Best Care for Heart Failure Patiets Patiets Give Istructios Whe Released from the Hospital Heart Failure Patiets Give Evaluatio of LVS Fuctio While i the Hospital or Scheduled for After the Patiet was Released Patiets Give ACE Ihibitor or ARB Prescriptio for LVSD Whe Released from the Hospital Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Overall Miesota Average 97% 95% 93% 94% 90% 90% * 94% 83% 70% 83% 86% 83% Quee Of Peace Hospital - New Prague Regia Medical Ceter - Hastigs Regios Hospital - St. Paul Ridgeview Medical Ceter - Wacoia St Fracis Regioal Medical Ceter - Shakopee St Joh s Hospital: Health East Care System - Maplewood St Joseph s Hospital: HealthEast Care System - St Paul Uited Hospital - St Paul Uity Hospital - Fridley Uiversity of Miesota Medical Ceter: Fairview - Mieapolis Woodwids Hospital: HealthEast Care System - Woodbury * * * * * * * * 84% * 97% * * * * * * * * * * 98% 97% 100% * * 95% 100% 99% 97% 100% 98% * 88% 94% 92% 100% 100% 100% 97% 100% 100% * * 100% * * 92% 92% 100% 92% * * * * * * * * * 96% 97% 99% * * 99% 99% 100% * * 100% * * 82% 80% 97% 97% 100% 96% 98% 99% 97% 99% 100% * 89% 80% 76% 98% 94% 100% 98% 99% 99% 98% 100% 99% * 98% 94% 93% 100% 99% 99% 98% 100% * * * 100% * * 95% 96% 100% 98% 97% 98% 100% 99% * 100% 99% * * 92% 91% 99% 100% 100% * * * * * * * * 70% 66% 97% 100% * * Sufficiet data ot available For more detailed iformatio, see appedices startig o page Hospital Measures November Health Care Quality Report

14 Quality of Care for Surgeries Sectio CONTENTS Quality of Heart Surgeries Heart Bypass Surgery: Number of Operatios ad Death Rate Agioplasty Heart Surgery: Number of Operatios ad Death Rate Table of Results...66 Appedix Table Quality of Care for Surgeries Quality of Other Surgeries Surgical Repair of a Abdomial Aortic Aeurysm: Number of Operatios ad Death Rate...63 Vagial Hysterectomy Surgical Site Ifectio Rate Surgery Patiets Whose Doctors Ordered Treatmet to Prevet Blood Clots After Certai Types of Surgeries...64 Surgery Patiets Who Received Treatmet at the Right Time to Prevet Blood Clots After Certai Types of Surgery Table of Results...66 Appedix Table Heart Surgeries Whe arteries carryig blood to the heart get blocked, this ca lead to a heart attack. There are a umber of surgical itervetios which ca ublock these blood vessels ad restore blood flow. Sice these surgeries are so techically difficult, outcomes will geerally be better at hospitals that perform more of these procedures. The measures i this sectio report the umber of surgeries performed ad the death rate for heart bypass surgery ad agioplasty heart surgery. Use the iformatio i this sectio to see how hospitals compare i their quality of care related to heart surgeries. November Health Care Quality Report Hospital Measures 61

15 Heart Bypass Surgery: Number of Operatios ad Death Rate Whe choosig a umber of operatios ad lower death rate. Heart bypass surgery ca restore good blood flow to the heart. The coroary artery bypass graft (CABG) surgery reroutes, or bypasses, blood aroud clogged arteries to improve blood flow ad oxyge to the heart. These measures show the umber of times a hospital performed a CABG ad the rate of patiet deaths related to the surgery. Research shows that, i geeral, whe hospitals do these procedures frequetly, they are more likely to have good results. Ofte, but ot always, a umber of operatios will have lower death rates. Why is this importat? The arteries that brig blood to the heart muscle ca become clogged by fat ad other substaces. This ca slow or stop blood flow through the heart s blood vessels, leadig to chest pai or a heart attack. A bypass surgery may be recommeded to implat tissue from aother part of the body to act as a tube that allows blood to flow aroud oe or more blocked or arrowed arteries. Although CABG is a fairly commo form of ope heart surgery, it is a techically difficult procedure. Errors durig the surgery may lead to other health problems, such as heart attack, stroke, ad death. About 3-4% of patiets die from CABG surgery. Your surgical risks are related to your age, other medical coditios ad the umber of procedures you have durig oe operatio. Hospitals that perform more of these surgeries have bee associated with better outcomes, icludig a lower umber of deaths. MEASURE source: AHRQ Ipatiet Quality Idicators (IQI 5: CABG Volume ad IQI 12: CABG Mortality Rate) Agioplasty Heart Surgery: Number of Operatios ad Death Rate Percutaeous traslumial coroary agioplasty (PTCA) ca restore good blood flow to the heart. PTCA surgery ivolves isertig a tube through the leg or arm, ito the heart, to ope blocked arteries ad keep them ope. These measures show the umber of times a hospital performed this procedure ad the rate of patiet deaths related to the surgery. Research shows that, i geeral, whe hospitals do these procedures frequetly, they are more likely to have good results. Ofte, but ot always, a umber of procedures will have lower death rates. Why is this importat? The arteries that brig blood to the heart muscle ca become clogged by fat ad other substaces. This ca slow or stop blood flow through the heart s blood vessels, leadig to chest pai or a heart attack. A PTCA may be recommeded to ope blocked arteries ad improve blood to flow to the heart. A catheter (log hollow tube) is iserted through the leg or arm, ito the heart, to ope blocked arteries. Whe choosig a umber of operatios ad lower death rate. Although PTCA is a fairly commo form of heart surgery, it is a techically difficult procedure. Errors durig surgery may lead to other health problems. About 1.31% of U.S. patiets die from PTCA surgery. Your surgical risks are related to your age ad other medical coditios. MEASURE SOURCE: AHRQ Ipatiet Quality Idicators (IQI 6: PTCA Volume ad IQI 30: PTCA Mortality Rate) 62 Hospital Measures November Health Care Quality Report

16 Other Surgeries Every year, more tha 15 millio Americas have surgery. Of these surgeries, those that are ot related to a emergecy are called elective surgeries. I these cases you have time to lear about your operatio. You ca also use this time to work with your doctor ad make sure this is the right treatmet for you. It is also importat to cosider the type of care provided at the hospital, which ca reduce your risk of complicatios or ifectios. There are steps hospitals ca take to lower the risk of complicatio ad provide quality of care related to surgeries. A example would be orderig the best medicatios to prevet blood clots after a operatio. Use the iformatio i this sectio to see how hospitals compare i their quality of care related to surgeries. Surgical Repair of a Abdomial Aortic Aeurysm: Number of Operatios ad Death Rate These measures show the quality of hospital care related to the surgical repair of a elarged artery or vei supplyig blood to the lower half of the body. The table below shows the umber of times a hospital performed this operatio ad rate of patiet deaths related to the surgery. This procedure is somewhat rare. Research shows that, i geeral, whe hospitals do these procedures frequetly, they are more likely to have good results. Ofte, but ot always, a hospital that has a umber of operatios will have lower death rates. Why is this importat? Surgery to repair a abdomial aortic aeurysm (AAA) is recommeded if the aeurysm causes additioal symptoms or grows to a size that is likely to burst. Abdomial aortic aeurysm repair is a fairly rare form of surgery. It is a techically difficult procedure with a high death rate compared to other forms of surgery. Whe choosig a umber of operatios ad lower death rate. Surgeos completig AAA repair eed to have great skill usig complex equipmet. Techical errors may lead to other health problems, such as irregular heartbeat, heart attack, ijury to the large itestie (coloic ischemia), ad death. MEASURE SOURCE: AHRQ Ipatiet Quality Idicators (IQI 4: Abdomial aortic aeurysm (AAA) repair volume ad IQI 11: Abdomial aortic aeurysm (AAA) repair mortality rate) November Health Care Quality Report Hospital Measures 63

17 Vagial Hysterectomy Surgical Site Ifectio Rate This measure shows the percet of vagial hysterectomy patiets with a surgical site ifectio. Why is this importat? Surgical site ifectios are a commo complicatio of care. They ca icrease the legth ad cost of a hospital stay. About 2.6 percet of operatios are complicated by surgical site ifectios every year. By followig prove strategies for ifectio prevetio, Whe choosig a hospital, look for the hospital that has a Lower Ifectio rate. these rates ca be reduced. This would save the patiet from this potetially serious complicatio ad the hospital the additioal resources associated with that care. MEASURE source: Healthcare-Associated Ifectio Measure (Vagial hysterectomy surgical site ifectio rate) Surgery Patiets Whose Doctors Ordered Treatmet to Prevet Blood Clots After Certai Types of Surgeries This measure shows the percet of surgery patiets whose doctors ordered treatmets to prevet blood clots after certai types of surgeries. I this case, the recommeded veous thromboembolism (VTE) prophylaxis, or treatmet to prevet blood clots, was ordered aytime from hospital arrival to 24 hours after surgery ed time. Why is this importat? Whe choosig a Certai surgeries icrease the risk that the patiet will develop a blood clot (veous thromboembolism). Whe patiets stay rate. still for a log time after some types of surgery, they are more likely to develop a blood clot i the veis of the legs, thighs, or pelvis. A blood clot slows dow the flow of blood, causig swellig, redess, ad pai. A blood clot ca also break off ad travel to other parts of the body. If the blood clot gets ito the lug, it is a serious problem that ca cause death. To help prevet blood clots from formig after surgery, doctors ca order treatmets to be used just before or after the surgery. These iclude blood-thiig medicatios, elastic support stockigs, or mechaical air stockigs that help with blood flow i the legs. Performace o this measure raged from 75 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-VTE-1: Surgery patiets with recommeded veous thromboembolism prophylaxis ordered) 64 Hospital Measures November Health Care Quality Report

18 Surgery Patiets Who Received Treatmet at the Right Time to Prevet Blood Clots After Certai Types of Surgery This measure shows the percet of surgery patiets who got treatmet at the right time to help prevet blood clots after certai types of surgeries. These treatmets eed to be started at the right time, which is typically durig the period that begis 24 hours before surgery ad eds 24 hours after surgery. Why is this importat? May factors ifluece a surgery patiet s risk of developig a blood clot, icludig the type of surgery. Whe patiets stay still for a log time after some types of surgery, they are more likely to develop a blood clot i the veis of the legs, thighs, or pelvis. A blood clot Whe choosig a rate. slows dow the flow of blood, causig swellig, redess, ad pai. A blood clot ca also break off ad travel to other parts of the body. If the blood clot gets ito the lug, it is a serious problem that ca sometimes cause death. Treatmets to help prevet blood clots from formig after surgery iclude blood-thiig medicatios, elastic support stockigs, or mechaical air stockigs that help with blood flow i the legs. Performace o this measure raged from 66 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-VTE-2: Surgery patiets who received appropriate veous thromboembolism prophylaxis withi 24 hours prior to surgery to 24 hours after surgery) November Health Care Quality Report Hospital Measures 65

19 Quality of Care for Surgeries Whe choosig a hospital, please check to see if the or lower rate. Number of Operatios: The umber of these surgeries performed. Risk Adjusted Rate: This takes the severity of each patiet s illess ito accout. Whe Compared to Expected: This compariso is based o how the hospital s risk adjusted rate measures up to the expected rate of other similar hospitals, idetifyig it as performig the SAME, BETTER, or WORSE. Whe selectig a hospital, look for oe with at least a SAME ratig ad ideally a BETTER ratig. HOSPITAL NAME Heart Bypass Surgery Number of Operatios Risk Adjusted Death Rate Heart Surgeries Whe Compared to Expected Rate Number of Operatios Agioplasty Heart Surgery Risk Adjusted Death Rate Whe Compared to Expected Rate Number of Operatios Surgical Repair of a Abdomial Aortic Aeurysm Risk Adjusted Death Rate Whe Compared to Expected Rate Other Surgeries Vagial Hysterectomy Surgical Site Ifectio Whe Compared to Other Hospitals Ifectio Rate Surgery Patiets Whose Doctors Ordered Treatmet to Prevet Blood Clots After Certai Types of Surgeries Surgery Patiets Who Received Treatmet at the Right Time to Prevet Blood Clots After Certai Types of Surgery Overall Miesota Average Abbott Northwester Hospital - Mieapolis Childre s Hospitals ad Cliics - Mieapolis Childre s Hospitals ad Cliics - St. Paul Fairview Ridges Hospital - Bursville Fairview Southdale Hospital - Edia Gillette Childre s Specialty Healthcare - St. Paul Heepi Couty Medical Ceter - Mieapolis Lakeview Memorial Hospital - Stillwater Maple Grove Hospital Mercy Hospital - Coo Rapids North Memorial Health Care - Robbisdale Northfield Hospital Park Nicollet Methodist Hospital - St. Louis Park 87% 86% 367 1% Better % Better 122 2% Better SAME 1% 99% 98% * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SAME 0% 87% 82% 189 1% Same 480 2% Same 36 7% Same SAME 0% 97% 93% * * * * * * * * * * * * * 50 0% Same 175 2% Same * * * * * 98% 96% * * * * * * * * * SAME 4% 82% 82% * * * * * * * * * * * * * 207 0% Better 954 1% Same 41 0% Same SAME 0% 99% 97% 108 2% Same 540 2% Same 47 8% Same SAME 0% 97% 97% * * * * * * * * * * * 86% 82% 221 3% Same 473 2% Same 50 3% Better SAME 2% 93% 93% * Sufficiet data ot available or procedure is ot performed at hospital. For more detailed iformatio, see appedices startig o page Hospital Measures November Health Care Quality Report

20 Quality of Care for Surgeries Whe choosig a hospital, please check to see if the or lower rate. Number of Operatios: The umber of these surgeries performed. Risk Adjusted Rate: This takes the severity of each patiet s illess ito accout. Whe Compared to Expected: This compariso is based o how the hospital s risk adjusted rate measures up to the expected rate of other similar hospitals, idetifyig it as performig the SAME, BETTER, or WORSE. Whe selectig a hospital, look for oe with at least a SAME ratig ad ideally a BETTER ratig. HOSPITAL NAME Heart Bypass Surgery Number of Operatios Risk Adjusted Death Rate Heart Surgeries Whe Compared to Expected Rate Number of Operatios Agioplasty Heart Surgery Risk Adjusted Death Rate Whe Compared to Expected Rate Number of Operatios Surgical Repair of a Abdomial Aortic Aeurysm Risk Adjusted Death Rate Whe Compared to Expected Rate Other Surgeries Vagial Hysterectomy Surgical Site Ifectio Whe Compared to Other Hospitals Ifectio Rate Surgery Patiets Whose Doctors Ordered Treatmet to Prevet Blood Clots After Certai Types of Surgeries Surgery Patiets Who Received Treatmet at the Right Time to Prevet Blood Clots After Certai Types of Surgery Overall Miesota Average 87% 86% Quee Of Peace Hospital - New Prague Regia Medical Ceter - Hastigs Regios Hospital - St. Paul Ridgeview Medical Ceter - Wacoia St Fracis Regioal Medical Ceter - Shakopee St Joh s Hospital: Health East Care System - Maplewood St Joseph s Hospital: HealthEast Care System - St Paul Uited Hospital - St Paul Uity Hospital - Fridley Uiversity of Miesota Medical Ceter: Fairview - Mieapolis Woodwids Hospital: HealthEast Care System - Woodbury * * * * * * * * * SAME 0% * * * * * * * * * * * * * 96% 94% 137 1% Better 613 1% Better 40 4% Better SAME 0% 92% 77% * * * 44 0% Same * * * SAME 0% 100% 100% * * * * * * * * * SAME 3% 94% 92% * * * * * * * * * SAME 1% 90% 89% 180 2% Better 500 1% Better 34 9% Same SAME 0% 93% 89% 200 1% Better 810 1% Same 29 4% Same SAME 1% 97% 97% * * * * * * * * * worse 6% 98% 96% 115 2% Same 377 1% Better * * * SAME 0% 91% 89% * * * * * * * * * SAME 0% 93% 92% * Sufficiet data ot available or procedure is ot performed at hospital. For more detailed iformatio, see appedices startig o page 259. November Health Care Quality Report Hospital Measures 67

21 Quality of Care for Medical Complicatios ad Ifectios Sectio CONTENTS Quality of Care for Medical Complicatios i the Hospital for Adult Patiets Death Rate From Failure to Idetify ad Treat a Serious Complicatio...69 Rate of Patiets with Bed Sores Rate of Blood Clots i the Lug or Large Vei After a Operatio Table of Results...76 Appedix Table Quality of Ifectio Prevetio Cetral Lie Ifectio (CLI) Prevetio Vetilator Associated Peumoia (VAP) Prevetio Surgery Patiets Give a Atibiotic Withi a Hour Before Surgery to Help Prevet Ifectio Surgery Patiets Give the Best Atibiotic to Help Prevet Ifectio...73 Surgery Patiets Whose Prevetive Atibiotics Were Stopped at the Right Time All Heart Surgery Patiets Whose Blood Sugar (Blood Glucose) is Kept Uder Good Cotrol i the Days Right After Surgery Quality of Care for Medical Complicatios ad Ifectios Medical Complicatios i the Hospital for Adult Patiets Certai complicatios ca arise after surgery. These may be life threateig, ultimately resultig i death if ot caught i time. These complicatios iclude coditios like acute real failure, which is whe the kideys stop workig properly. Other complicatios might be peumoia or cardiac arrest. However, there are steps that hospitals ca take to limit the umber of complicatios. The measures i this sectio show the rates of several complicatios. Use this iformatio to see how well hospitals are doig to prevet various problems. Those hospitals with a lower rate o the three measures are doig a better job i their quality of care for medical complicatios. Surgery Patiets Needig Hair Removed Before Surgery Usig a Safer Method Surgery Patiets o Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker Durig the Perioperative Period...75 Table of Results...76 Appedix Table Hospital Measures November Health Care Quality Report

22 Medical Complicatios: Death Rate From Failure to Idetify ad Treat a Serious Complicatio Patiets may develop serious health coditios while they are i the hospital after surgery. These coditios ca result i permaet disability ad eve death, if ot treated quickly. This patiet safety measure shows the rate of deaths from these surgery complicatios. Why is this importat? Whe a patiet dies this way, the death is called a failure to rescue. The serious health coditios after surgery icluded i the failure to rescue measure iclude: Acute real failure (sudde kidey failure) Deep veous thrombosis (blood clot that forms i a vei deep i the body) Peumoia Sepsis (blood ifectio) Shock ad/or cardiac arrest (severe heart attack) Upper gastroitestial bleedig (i the esophagus, stomach, ad first part of the itestie) Whe choosig a hospital, look for the Lower rate. I 2003, about 128 patiets died for every 1,000 patiets at risk of developig these additioal health problems i the hospital. Early detectio of serious health coditios after surgery ad their quick treatmet may prevet a patiet from dyig. May hospitals have developed systems to detect patiets i crisis ad to respod immediately. Nursig staff eed to be able to otice problems ad accurately uderstad what they mea ad respod with appropriate care. MEASURE SOURCE: AHRQ Patiet Safety Idicator (PSI 4: Death amog surgical ipatiets with serious treatable complicatios) Medical Complicatios: Rate of Patiets with Bed Sores A pressure ulcer is a ski woud that forms whe patiets stay i oe positio for too log without shiftig their weight. This patiet safety measure shows the percet of patiets that develop pressure ulcers, also kow as decubitus ulcers or bed sores, durig their stay i the hospital. Whe choosig a hospital, look for the Lower rate. Why is this importat? Costat pressure agaist the ski reduces the blood supply to that area ad that ski dies. People with limited ability to move are at risk of developig bed sores while i the hospital. This ofte happes if you use a wheelchair or you are uable to get out of bed, eve for a short period of time after surgery or a ijury. People with thi ski, like ski that has lost muscle ad fat uder the ski, also ca develop pressure ulcers if they repeatedly rub agaist somethig, such as a bed sheet, cast, or brace. The most commo places for pressure ulcers are over boey areas like the elbow, heels, hips, akles, shoulders, back, ad the back of the head. Pressure ulcers ofte cause ifectios that ca lead to loger hospital stays, costs, ad eve death. I the U.S., 7 to 10% of patiets will develop a pressure ulcer durig their hospital stay. Those most at risk iclude older people, stroke victims, ad people with demetia or head ijuries. Seiors are at risk as they typically have thi ski. Health coditios that affect blood flow, such as diabetes, ad poor diet icrease the chace of pressure ulcers. Care processes i hospitals ca help prevet pressure ulcers. These iclude makig sure that patiets chage positio every 2 hours or more. Hospitals also use protectio ad paddig to prevet rubbig agaist the ski, ad maitai hydratio, utritio ad hygiee. MEASURE SOURCE: AHRQ Patiet Safety Idicator (PSI 3: Pressure ulcer) November Health Care Quality Report Hospital Measures 69

23 Medical Complicatios: Rate of Blood Clots i the Lug or Large Vei After a Operatio This patiet safety measure shows the percet of patiets that develop two problems with blood clots after surgery: postoperative pulmoary embolism (PE) or deep vei thrombosis (DVT). Why is this importat? Deep vei thrombosis (DVT) is a blood clot that forms i a vei deep i the body. Blood clots occur whe blood thickes ad clumps together. Most deep vei blood clots occur i the lower leg or thigh. A pulmoary embolism (PE) is a sudde plug i a lug artery, usually due to a blood clot that traveled to the lug from a vei i the leg. PE is a serious coditio. It ca damage the lugs ad other orgas i the body ad cause death. Whe choosig a hospital, look for the Lower rate. Both DVT ad PE ca happe after surgery, especially if patiets are uable to leave their beds. People havig hip or kee replacemet surgeries are at greater risk of havig problem blood clots. Remaiig still durig ay type of surgery ca lead to clots developig. The loger you are uder geeral aesthesia, the greater your risk of serious clots. A estimated 8.96 out of 1000 patiets developed PEs after surgeries i the U.S. i Hospitals ca help prevet problems with blood clots by providig blood thiig medicatios to people at risk of clots, by usig methods to squeeze the legs to improve blood flow ad by havig patiets move as soo as possible after surgery. MEASURE SOURCE: AHRQ Patiet Safety Idicator (PSI 12: Postoperative pulmoary embolism (PE) or deep vei thrombosis (DVT)) 70 Hospital Measures November Health Care Quality Report

24 Ifectio Prevetio Hospitals ca improve surgical care ad reduce the risk of woud ifectio after surgery by providig the right medicies at the right time o the day of surgery. There are also steps that you, as a patiet, ca take to make sure the surgery is as safe as possible. For example, your doctor or urse ca tell you how to wash with a atibiotic soap the day before surgery. You ca also give your doctor or urse a list of all your medicatios, icludig vitamis, herbal medicies, ad over-the-couter medicatios. You should also tell your doctor or urse about ay allergies ad bad reactios to aesthesia. Sometimes patiets get a ifectio after surgery, eve if the hospital took steps to prevet it. Here are sigs to look out for: The surgical woud is red, hot, ad swolle. You have a fever of over 100 degrees after you go home. A smelly or yellow/gree fluid is comig out of the woud. Your pai is icreasig eve though you are takig pai medicatio. Call your doctor or local hospital immediately if you have ay of these sigs. Ifectio Prevetio: Cetral Lie Ifectio (CLI) Prevetio A Cetral Lie Ifectio Prevetio Budle is a package of prove itervetios that produce dramatic reductios i the icidece of bloodstream ifectios. These types of ifectios are commo i Itesive Care Uits where itraveous catheters are used. This measure shows the percet of patiets who were give all of the followig evidece-based itervetios: Use of had hygiee by the perso performig the procedure. Documetatio that the perso performig the procedure is usig precautios, such as wearig a sterile gow ad gloves ad coverig the patiet s head ad body with a large sterile drape. Documetatio of the use of a atiseptic wipe(s). Documetatio from the caregiver about why they chose the site or documetatio about the cliical evidece supportig the caregiver s choice of the site. Daily assessmet is performed regardig the cotiued ecessity of catheter use. Whe choosig a rate. Why is this importat? Ifectios are a commo complicatio of care. They ca icrease the legth ad cost of a hospital stay. By followig prove strategies for ifectio prevetio, ifectio rates ca be reduced. This would save the patiet from this potetially serious complicatio ad the hospital the additioal resources associated with that care. I this case, followig the Cetral Lie Ifectio Prevetio Budle would sigificatly reduce ifectios i this area. Performace o this measure raged from zero percet to 100 percet. MEASURE SOURCE: Healthcare-Associated Ifectio Measure (Cetral Lie Ifectio (CLI) Prevetio Budle Compliace) November Health Care Quality Report Hospital Measures 71

25 Ifectio Prevetio: Vetilator Associated Peumoia (VAP) Prevetio A Vetilator Associated Peumoia Budle is a package of evidece-based itervetios that produce dramatic reductios i the icidece of vetilatorassociated peumoia. These types of ifectios are commo i Itesive Care Uits where mechaical vetilators are used. This measure shows the percet of patiets who are give every step i the package of evidece-based itervetios. The steps are: Documetatio that the head of the bed is elevated more tha 30 degrees or greater. Documetatio that appropriate medicatio is give to prevet ulcers (sores). Whe choosig a rate. Documetatio of the use of appropriate mechaical equipmet to prevet ulcers (sores). Documetatio of reduced sedatio or a assessmet of why sedatio is ot reduced. Documetatio that there is a daily assessmet of whether the patiet ca be weaed of the eed for the vetilator. Why is this importat? Ifectios are a commo complicatio of care. They ca icrease the legth ad cost of a hospital stay. By followig prove strategies for ifectio prevetio, ifectio rates ca be reduced. This would save the patiet from this potetially serious complicatio ad the hospital the additioal resources associated with that care. I this case, followig the Vetilator Associated Peumoia Prevetio measure would sigificatly reduce ifectios i this area. Ifectio Prevetio: Surgery Patiets Give a Atibiotic Withi a Hour Before Surgery to Help Prevet Ifectio This measure shows the percet of surgical patiets with prophylactic atibiotics, also kow as prevetative atibiotics, started withi oe hour before the surgical icisio. NOTE: Patiets who got vacomyci or a fluoroquioloe for prophylactic atibiotics should have the atibiotics iitiated withi two hours prior to surgical icisio. Due to the loger ifusio time required for vacomyci or a fluoroquioloe, it is acceptable to start these atibiotics withi two hours prior to icisio time. Why is this importat? Surgical woud ifectios ca be preveted. Medical research shows that surgery patiets who get atibiotics withi the hour before their surgery are less likely to get woud ifectios. Gettig a atibiotic earlier, or after surgery begis, is ot as effective. Hospital staff should make sure surgery patiets get atibiotics at the right time. Whe choosig a rate. Performace o this measure raged from 53 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-If-1: Prophylactic atibiotic received withi oe hour prior to surgical icisio) Performace o this measure raged from 79 percet to 100 percet. MEASURE SOURCE: Healthcare-Associated Ifectio Measure (Vetilator Associated Peumoia (VAP) Prevetio Budle Compliace) 72 Hospital Measures November Health Care Quality Report

26 Ifectio Prevetio: Surgery Patiets Give the Best Atibiotic to Help Prevet Ifectio This measure shows the percet of surgical patiets who received the best prophylactic atibiotics, also kow as prevetive atibiotics, cosistet with curret guidelies for their surgical procedure. These guidelies are specific to each type of surgical procedure. Why is this importat? Surgical woud ifectios ca be preveted. Medical research has show that certai atibiotics work better to prevet woud ifectios for certai types of surgery. Hospital staff should make sure patiets get the atibiotic that works best for their type of surgery. Whe choosig a rate. Performace o this measure raged from 91 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-If-2: Prophylactic atibiotic selectio for surgical patiets) Ifectio Prevetio: Surgery Patiets Whose Prevetive Atibiotics Were Stopped at the Right Time This measure shows the percet of surgical patiets whose prophylactic atibiotics were discotiued withi 24 hours after surgery ed time (withi 48 hours for coroary artery bypass graft (CABG) or other cardiac surgery). NOTE: The Society of Thoracic Surgeos (STS) Practice Guidelie for Atibiotic Prophylaxis i Cardiac Surgery (2006) idicates that there is o reaso to exted atibiotics beyod 48 hours for cardiac surgery ad very explicitly states that atibiotics should ot be exteded beyod 48 hours eve with tubes ad drais i place for cardiac surgery. Why is this importat? Atibiotics are ofte give to patiets before surgery to prevet ifectio. Takig these atibiotics for more tha 24 hours after routie surgery is usually ot ecessary. Cotiuig the medicatio loger tha ecessary ca icrease the risk of side effects such as stomach aches Whe choosig a rate. ad serious types of diarrhea. Also, whe atibiotics are used for too log, patiets ca develop resistace to them ad the atibiotics wo t work as well. Performace o this measure raged from 59 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-If-3: Prophylactic atibiotics discotiued withi 24 hours after surgery ed time) November Health Care Quality Report Hospital Measures 73

27 Ifectio Prevetio: All Heart Surgery Patiets Whose Blood Sugar (Blood Glucose) is Kept Uder Good Cotrol i the Days Right After Surgery This measure shows the percet of cardiac surgery patiets with cotrolled 6 A.M. blood glucose ( 200 mg/dl) o postoperative day oe ad postoperative day two with Surgery Ed Date beig postoperative day zero. Why is this importat? Eve if heart surgery patiets do ot have diabetes, keepig their blood sugar uder good cotrol after surgery lowers the risk of ifectio ad other problems. Uder good cotrol meas their blood sugar should be 200 mg/dl or less whe checked first thig i the morig. Whe choosig a rate. Performace o this measure raged from 50 percet to 97 percet. Ifectio Prevetio: Surgery Patiets Needig Hair Removed Before Surgery Usig a Safer Method This measure shows the percet of surgery patiets with appropriate surgical site hair removal. No hair removal, or hair removal with clippers or hair removal cream is cosidered appropriate. Shavig is cosidered iappropriate. Why is this importat? Preparig a patiet for surgery may iclude removig body hair from ski i the area where the surgery will be doe. Medical research has show that shavig with a razor ca icrease the risk of ifectio. It is safer to use electric clippers or hair removal cream. Performace o this measure raged from 77 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-If-6: Surgery patiets with appropriate hair removal) Whe choosig a rate. MEASURE SOURCE: Hospital Compare Measure (SCIP-If-4: Cardiac surgery patiets with cotrolled 6 a.m. postoperative blood glucose) 74 Hospital Measures November Health Care Quality Report

28 Ifectio Prevetio: Surgery Patiets o Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker Durig the Perioperative Period This measure is used to assess the percet of surgery patiets o beta-blocker therapy prior to arrival who received a beta-blocker durig the perioperative period. The perioperative period is defied as 24 hours prior to surgical icisio through discharge from the post-aesthesia care/recovery area. Why is this importat? It is ofte stadard procedure to stop patiets usual medicatios for awhile before ad after their surgery. But if patiets who have bee takig beta blockers suddely stop takig them, they ca have heart problems such as a fast heart beat. For these patiets, stayig o beta blockers before ad after surgery makes it less likely that they will have heart problems. Whe choosig a rate. Performace o this measure raged from 52 percet to 100 percet. MEASURE SOURCE: Hospital Compare Measure (SCIP-Card-2: Surgery patiets o beta-blocker therapy prior to arrival who received a betablocker durig the perioperative period) November Health Care Quality Report Hospital Measures 75

29 Quality of Care for Medical Complicatios ad Ifectios Whe choosig a hospital, please check to see if the or lower rate. Risk Adjusted Rate: This takes the severity of each patiet s illess ito accout. Whe Compared to Expected: This compariso is based o how the hospital s risk adjusted rate measures up to the expected rate of other similar hospitals aroud the coutry, idetifyig it as performig the SAME, BETTER, or WORSE. Whe selectig a hospital, look for oe with at least a SAME ratig ad ideally a BETTER ratig. HOSPITAL NAME Deaths From Failure to Idetify ad Treat a Serious Complicatio Risk Adjusted Rate Medical Complicatios Whe Compared to Expected Rate Patiets with Bed Sores Risk Adjusted Rate Whe Compared to Expected Rate Blood Clots i the Lug or Large Vei After a Operatio Risk Adjusted Rate Whe Compared to Expected Rate Cetral Lie Ifectio (CLI) Prevetio Vetilator Associated Peumoia (VAP) Prevetio Surgery Patiets Give a Atibiotic Withi a Hour Before Surgery to Help Prevet Ifectio Ifectio Prevetio Surgery Patiets Give the Best Atibiotic to Help Prevet Ifectio Surgery Patiets Whose Prevetive Atibiotics Were Stopped at the Right Time All Heart Surgery Patiets Whose Blood Sugar is Kept Uder Good Cotrol Right After Surgery Surgery Patiets Needig Hair Removed Before Surgery Usig a Safer Method Surgery Patiets o Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker Durig the Perioperative Period Overall Miesota Average Abbott Northwester Hospital - Mieapolis Childre s Hospitals ad Cliics - Mieapolis Childre s Hospitals ad Cliics - St. Paul Fairview Ridges Hospital - Bursville Fairview Southdale Hospital - Edia Gillette Childre s Specialty Healthcare - St. Paul Heepi Couty Medical Ceter - Mieapolis Lakeview Memorial Hospital - Stillwater Maple Grove Hospital Mercy Hospital - Coo Rapids North Memorial Health Care - Robbisdale Northfield Hospital Park Nicollet Methodist Hospital - St. Louis Park 87% 96% 86% 94% 94% 87% 96% 87% 10% Same 0% Better 1% Better 96% 79% 97% 99% 97% 92% 100% 92% * * 0% Same 0% Same * * * * * * * * * * 0% Same 0% Same * * * * * * * * 3% Same 0% Better 0% Better 100% 100% 97% 99% 96% * 100% 94% 9% Same 0% Better 1% Better 94% 98% 98% 99% 95% 90% 78% 96% * * * * 1% Same * * * * * * * * 15% Same 0% Better 2% Worse 44% 80% 96% 98% 96% 84% 100% 97% 11% Same 1% Same 0% Better 41% * 97% 99% 99% * 100% 95% * * * * * * * * * * * * * * 7% Same 0% Better 1% Better 97% 100% 96% 99% 98% 97% 100% 95% 8% Same 0% Better 1% Same 80% 98% 92% 95% 92% 50% 100% 76% * * 0% SAME 0% SAME * * 94% 99% 95% * 99% 93% 9% Same 0% Better 1% Better 94% 91% 98% 99% 97% 92% 100% 88% * Sufficiet data ot available For more detailed iformatio, see appedices startig o page Hospital Measures November Health Care Quality Report

30 Quality of Care for Medical Complicatios ad Ifectios Whe choosig a hospital, please check to see if the or lower rate. Risk Adjusted Rate: This takes the severity of each patiet s illess ito accout. Whe Compared to Expected: This compariso is based o how the hospital s risk adjusted rate measures up to the expected rate of other similar hospitals aroud the coutry, idetifyig it as performig the SAME, BETTER, or WORSE. Whe selectig a hospital, look for oe with at least a SAME ratig ad ideally a BETTER ratig. HOSPITAL NAME Deaths From Failure to Idetify ad Treat a Serious Complicatio Risk Adjusted Rate Medical Complicatios Whe Compared to Expected Rate Patiets with Bed Sores Risk Adjusted Rate Whe Compared to Expected Rate Blood Clots i the Lug or Large Vei After a Operatio Risk Adjusted Rate Whe Compared to Expected Rate Cetral Lie Ifectio (CLI) Prevetio Vetilator Associated Peumoia (VAP) Prevetio Surgery Patiets Give a Atibiotic Withi a Hour Before Surgery to Help Prevet Ifectio Ifectio Prevetio Surgery Patiets Give the Best Atibiotic to Help Prevet Ifectio Surgery Patiets Whose Prevetive Atibiotics Were Stopped at the Right Time All Heart Surgery Patiets Whose Blood Sugar is Kept Uder Good Cotrol Right After Surgery Surgery Patiets Needig Hair Removed Before Surgery Usig a Safer Method Surgery Patiets o Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker Durig the Perioperative Period Overall Miesota Average 87% 96% 86% 94% 94% 87% 96% 87% Quee Of Peace Hospital - New Prague Regia Medical Ceter - Hastigs Regios Hospital - St. Paul Ridgeview Medical Ceter - Wacoia St Fracis Regioal Medical Ceter - Shakopee St Joh s Hospital: Health East Care System - Maplewood St Joseph s Hospital: HealthEast Care System - St Paul Uited Hospital - St Paul Uity Hospital - Fridley Uiversity of Miesota Medical Ceter: Fairview - Mieapolis Woodwids Hospital: HealthEast Care System - Woodbury * * 0% Same 0% Same * * 95% 98% 98% * 100% * * * 0% Same 1% Same * * 92% 99% 99% * 100% 98% 10% Same 0% Better 1% Worse 95% 93% 93% 99% 95% 97% 99% 77% 10% Same 0% Better 1% Same 83% 80% 96% 100% 100% * 100% 100% 24% Worse 0% Better 0% Better 99% 98% 96% 98% 98% * 100% 92% 9% Same 0% Better 1% Same 65% 92% 93% 98% 96% * 100% 89% 7% Better 0% Better 1% Same 90% 92% 94% 99% 97% 83% 99% 89% 16% Same 0% Better 1% Better 96% 88% 96% 98% 96% 92% 100% 91% 9% Same 0% Better 0% Better 93% 100% 96% 99% 97% * 100% 93% 11% Same 0% Better 1% Better 100% 99% 97% 98% 94% 89% 100% 95% 7% Same 0% Better 0% Better 52% 84% 97% 100% 98% * 100% 97% * Sufficiet data ot available For more detailed iformatio, see appedices startig o page 259. November Health Care Quality Report Hospital Measures 77

31 Quality of Care for Other Coditios Sectio CONTENTS Quality of Peumoia Care The Best Care for Peumoia Patiets Patiets Assessed ad Give Peumoia Vacciatio Blood Test Give to Patiet Prior to Receivig Atibiotics Patiets Give Advice or Couselig About Quittig Smokig While i the Hospital Patiets Give Iitial Atibiotic(s) Withi Six Hours After Gettig to the Hospital Patiets Give the Most Appropriate Iitial Atibiotic(s) Patiets Assessed ad Give Iflueza Vacciatio Table of Results...86 Appedix Table Quality of Hip Fracture Treatmet Hip Fracture Surgery: Death Rate for Patiets with a Broke Hip...83 Table of Results...86 Appedix Table Quality of Care for Other Coditios Peumoia Care Peumoia is a serious lug ifectio that causes difficulty breathig, fever, cough ad fatigue. Peumoia is caused by a viral or bacterial ifectio that fills your lugs with mucus. This lowers the oxyge level i your blood. Symptoms of peumoia ca iclude the followig: Difficulty breathig Wet cough. Your mucus may look gree or bloody. Chest pai Fever ad chills Fatigue These measures show some of the recommeded treatmets for peumoia. Quality of Childbirth Rate of Obstetric Tearig Vagial Delivery with Medical Istrumets Rate of Obstetric Tearig Vagial Delivery without Medical Istrumets Table of Results...86 Appedix Table Hospital Measures November Health Care Quality Report