Medicare has started punishing hundreds of hospitals nationally, including 15 in Colorado, for high rates of infections and avoidable medical complications. The result: the insurance program for low-income Americans withheld millions in payments.
And even though the state ranks 10th best for patient safety in one survey, and a state Department of Public Health report also suggests Colorado fares well on infection rates in hospitals compared to other states, it was one of nine where a third of the hospitals Medicare evaluated were penalized.
Hospitals here, aware of the scrutiny, say they're working on everything from better processes to revamped designs in order to cut errors.
Hospital design a factor
The way hospitals are designed can play a factor in medical mistakes, said Dr. Shawn Dufford. He’s the chief medical officer at the new $623 million St. Joseph Hospital in Denver.
On a recent tour, Dufford showed off new lift systems in every room to help move patients, and avoid falls.
The hospital has a barcoded system for delivery of medication. Most of its 21 operating rooms, outfitted with sophisticated high tech gear, are designed exactly the same. “It makes it a lot safer and it decreases the risk,” Dufford said.
The patient beds, cabinets, anesthesia machines and more are always located in the same spot.
“So you’re not having any confusion going into a room saying ‘Oh where is it in this room? Where is it in that room?’ " said Dufford. "If you hard wire a lot of those processes your staff does a lot better.”
Dufford, who is also a pilot, said checklists, widely used in aviation, have become commonplace in medicine too. So has a more collaborative approach, encouraging everyone on the team to speak up about a patient’s treatment.
“It’s a big culture shift," Dufford said. "It used to be doctors were the same as an airline captain: 'It’s my operating room or my plane and I’m going to do what I want.' Now it’s a team sport.”
Training and accountability
That philosophy extends to the education of providers, said Dr. Brian Dwinnell, who directs graduate education at Presbyterian/St. Luke's hospital. He said his doctors in training are taught to communicate, report mistakes and discuss them with patients. And they do training exercises with actors, learning to apologize to families for errors. He said studies have shown it improves transparency and reduces litigation costs.
“It’s been a sea change for patient safety," said Dwinnell. "But it’s also been a huge sea change for medical education.”
The non-profit Think About It Colorado aims to educate both consumers and providers. It publishes hospital report cards, gives tips on filing a complaint and provides checklists for patients visiting a doctor’s office or having surgery. The group’s board chair Donna Kusuda said many people need help navigating a complicated system.
"Probably many of them have never had a physician or primary care provider, so it's a new experience for them," said Kusuda.
The Affordable Care Act has enabled thousands of Coloradans to obtain insurance and enter the state's health care system. Kusada said it’s critical for new patients be proactive about their care, something new for many.
“Many of them may not have really been actively engaged in the healthcare system,” says Kusuda. "It's a new experience for them."
Dr. Heidi Wald, a patient safety expert at the University of Colorado's School of Medicine, said she thinks things are moving in the right direction. But she concedes, in health care, like other fields "the stakes are awfully high.”
And the system is as complex and busy as ever.