Role of Clinical Pathology Laboratories in Hospitals may be Boosted by New Public Report
Transparency in provider outcomes took another step forward recently as the State of Oregon published its first report of hospital-acquired infections covering the year 2009. Because pathologists and clinical laboratory administrators are likely to eventually see similar public reporting in their states, this development has nationwide implications.
The report was compiled and released by the Office of Oregon Health Policy Research (OHPR). It compares healthcare-acquired infection (HAI) rates at 58 hospitals and health facilities across the state.
This is the first time this information has been released directly to the public, as called for under a new state law that was sponsored by Representative Mitch Greenlick (D- Portland). This law created the Oregon Health Care Acquired Infection Reporting Program. The program aims to bring greater transparency to healthcare. It requires hospitals to report the incidence of the three most common HAI’s: central line blood stream, coronary bypass graft, and knee replacement infections.
Oregon is one of the 10 states nationally that have HAI programs. However, many hospitals voluntarily report HAI data to the National Healthcare Security Network. This database was used by OHPR to compare performance by Oregon hospitals with facilities nationwide.
For Oregon residents, there was some good news. Oregon hospitals outperformed facilities nationally in 2009, with lower than average HAI rates overall. Within the state, however, the report revealed significant differences between facilities. For example, Portland’s Adventist Medical Center had zero central line bloodstream infections in the intensive care unit during 2009, while similarly-sized OHSU Hospital, also in Portland, had nearly triple the national average for central line HAIs.
Likewise, Ashland Community Hospital, a small hospital in southwestern Oregon, reported no HAIs for knee replacement, while Mid-Columbia Medical Center in the north-central community of The Dalles had more than five times the national average for similar-sized facilities.
Of course, infection rate comparisons can be misleading, because just one infection at the smallest facility—often the result of chance, rather than performance—generates a higher than average HIA rate.
Additionally, infection statistics of hospitals that treat the sickest patients often look worse than other hospitals because their patients are so vulnerable. John Townes, M.D., Director of Infection Prevention and Control at OHSU, told Oregonian reporter Joe Rajos-Burke, “I think it’s difficult to know how meaningful those differences are.” He pointed out that OHSU treats patients that most other hospitals don’t. “A number of the central-line infections we reported occurred among transplant patients,” he said.
Even so, hospitals that make HIAs a top priority were easy to spot in the report. John Santa, M.D., Director of Health Ratings for Consumer Reports, noted in the Oregonian article, “…it’s not so easy to dismiss stark differences among similar-sized hospitals. This is an indicator of priorities in that hospital, the culture of care.”
For instance, Adventist Medical Center saw its HIA rate drop dramatically after implementing, in 2006, a similar infection control program that was developed at Johns Hopkins Medical Center. Adventist Medical Center has not reported a central line infection since spring 2007.
“I think Oregon can take some pride in the results [of the report],” observed Steve Gordon, M.D., Chief Quality Officer of PeaceHealth Oregon, to TheOregonPolitico.com. “At the same time, these reports demonstrate that there’s still work for us to do.”
Greenlick said the HAI results are not as important as the fact that this information is now public. “I really believe that public disclosure is instrumental in getting hospitals to do what they need to do to prevent hospital acquired infections,” he said in the Politico article. “I want a lot more things reported and I want them reported fast.”
Sean Kolmer, Deputy Administrator for the OHPR, told the Oregonian reporter Joe Rajos-Burke, “Hopefully this program will empower consumers to make choices.” He said the program will eventually be expanded to conditions that affect women and children.
Oregon officials estimate that the average HAI adds $32,000 to a hospital bill. They estimate that HAIs cost the state $15 million in excess healthcare expenses in 2005 alone.
Public reporting of hospital-acquired infections, along with the resulting ranking of hospital performance, is an auspicious development for hospital laboratories. Motivated by the need to demonstrate top-rankings in their region, hospital administrators will turn to their laboratories to provide the essential testing required to quickly and accurately to identify infections. Close scrutiny of infection prevention and control practices can also raise the profile and contributions from pathologists, clinical laboratory scientists, and microbiologists working within the hospital.
Clinical laboratories will be instrumental in efforts to improve hospital infection rates, because lab tests are the primary tool used to identify and track infections and analyze antibiotic resistance. Pathologists can expect to play a key role as clinicians will look to them for new and updated information on effective antibiotics and clinical isolates.