For example, only 21 states have passed laws requiring some reporting of surgical site infections (SSI)

There is growing pressure on states to collect and report standardized, accurate data on surgical site infections (SSI) and to make that data easily accessible to patients. This renewed focus on open access to performance quality data represents another milestone in the trend toward transparency in provider outcomes and pricing for consumers.

One consequence of increased tracking and reporting of surgical site infections by hospitals is more utilization of clinical laboratory Clinical laboratory tests that are used to identify infections and help physicians monitor the progress of patients with SSIs. Pathologists  and microbiologists have an important role in helping hospitals reduce the number of SSIs.

A recent study by researchers from Johns Hopkins Medicine examined the current status of SSI reporting throughout the United States. SSIs are “common, costly, and often preventable,” the authors wrote. Researchers estimate that surgical site infections occur in up to 25% of patients after major surgical procedures, resulting in more than 8,000 deaths annually.

Published online in the Journal for Healthcare Quality, the study found that reporting accurate data on measures such as rates of SSIs can be an inexpensive way to actually reduce such infections, a story in the Palm Beach Daily News reported. Even so, at the time of the September 2010 study, only 21 states had SSI reporting laws. Of those, only eight states made the data publicly available in an easily accessible format.

This graphic shows the primary sources of health-acquired infections (HAI). The Centers for Disease Control and Prevention (CDC) estimates that HAIs cost health systems an average of $5,018 per patient. Surgical site infections make up about 22% of all HAIs. (Graphic copyright by Infection Disease Special Edition.)

This graphic shows the primary sources of health-acquired infections (HAI). The Centers for Disease Control and Prevention (CDC) estimates that HAIs cost health systems an average of $5,018 per patient. Surgical site infections make up about 22% of all HAIs. (Graphic copyright by Infection Disease Special Edition.)

“A lot of information is not available to the public,” stated study leader Martin A. Makary, M.D., M.P.H, Associate Professor of Surgery at the Johns Hopkins University School of Medicine. “[I]f it were, hospitals would be motivated to improve. Right now, a hospital can have high complication rates, high readmission rates and high infection rates, but because patients can’t look up this information, they’re essentially walking in blind.”

Public Reporting Motivates Hospitals to Improve

Makary provided statistics from New York State as an example of the impact transparency can have on outcomes. Four years after the state began requiring public reporting of death rates from coronary artery bypass surgery, average hospital death rates from the operation dropped 41%.

Makary believes one reason for the dramatic drop was that “poorly performing hospitals had an incentive to look better to consumers making health care decisions,” wrote the The Lund Report in its coverage of the story.

Current Hodgepodge of State Reporting Is Not Working

According to the Johns Hopkins research findings, the current system of reporting critical measures of healthcare quality is non-standardized and haphazard. There are no national requirements for measuring or reporting hospital SSI rates. State-level monitoring occurs with little coordination among the states. Additionally, states don’t always specify how data are collected. Makary observed that this results in non-uniform reporting that can make comparisons impossible.

“It is important to use a common method or at a minimum ensure common parameters, inputs and definitions are used,” Makary stated. “Without that, it is difficult for consumers, payers or regulators to compare infections within or across states. Unless we are comparing apples to apples, public disclosure has the potential to mislead patients instead of help them.”

The findings of this study suggest that only standardized national guidelines governing disclosure can provide a clear picture of how well a hospital is doing at preventing patient harm. Interestingly, the study authors further observed that the lack of a uniform national standard may put hospitals that are better at collecting data at a disadvantage. Their rates may appear higher than those of hospitals that don’t look for infection rates as rigorously.

The Centers for Medicare and Medicaid Services (CMS) recently announced that hospitals must soon report surgical site infection rates for select procedures, the Lund Report said. But Makary claims that the new requirement falls short and that Medicare needs to quickly expand the program and speed up the transition to uniform public reporting for all hospitals.

Pathologists and clinical laboratory managers who work in hospital laboratories have different experiences with the surgical site infection (SSI) reporting requirement, depending on which state their hospital is located. One common denominator, however, is the need to quickly identify antibiotic-resistant strains of bacteria, such as MRSA (Methicillin-resistant Staphylococcus aureus) among hospital inpatients. Most hospitals and health systems have active programs in place to detect such infections, isolate the patients, and initiate appropriate treatment as early as possible.

—Pamela Scherer McLeod

Related Information:

Johns Hopkins Medicine study: National standard for hospital infection reporting needed

Public Disclosure of Hospital Infection Rates Varies by State

Hospital Outcomes Transparency Gets New Tools in Washington State

Veterans Administration’s Website with Hospital Compare Website Delivers Improved Transparency to Patients

Clinical Pathology Labs Should Plan on Greater Transparency in Test Prices and Patient Outcomes

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