St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.

St. Joseph’s London Hospital has notified the state that it will no longer perform coronary artery bypass graft surgery (CABG), the traditional open-chest cardio-thoracic surgical procedure used to restore blood flow to the heart of people with severe coronary artery atherosclerosis. Before the advent of the the less invasive angioplasty and stenting, CABG was the main surgical approach to re-vascularization of a diseased heart. For certain combinations of coronary artery disease, and in some clinical settings, CABG remains the preferred approach today.

Why fewer invasive procedures?
In Kentucky, the frequency of both angioplasty and CABG have been gradually decreasing, presumably because the effectiveness of aggressive medical therapy is better recognized, and because research showed that the invasive approaches were being used in circumstances where they offered no advantage over non-invasive treatment. Treatment of coronary artery disease is lucrative for hospitals and physicians alike which unfortunately caused some to stretch the envelope beyond what could be justified medically, even to the point of fraud. That bubble is bursting and accounts for a some if not much of the overall decrease in invasive procedures.

Where will patients go?
The new plan in London is to transfer those patients requiring emergency surgery to one of the nearer hospitals capable of treating such a patient, presumably Pikeville, Hazard, Corbin, Asheville, Summerset, or Lexington. (Some of these hospitals perform fewer CABGs than in London!) For non-emergency surgery, patients will be referred to another KentuckyOne hospital– St. Joseph’s Lexington. Angioplasty and stenting will continue to be performed at St. Joseph’s London presumably with safeguards in place to make sure that the most appropriate procedure will be offered for medical reasons and not for convenience. Continue reading “St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.”

Safety of Louisville Hospitals: Are we there yet?

Further consideration of recent Leapfrog Hospital Safety Scores.

Earlier this month I offered a preliminary description of the third iteration of Leapfrog’s Hospital Safety Scores for Kentucky’s hospitals. I continued to be concerned about the large and increasing number of Kentucky Hospitals that escape evaluation, including some that should be looked at the hardest. Of the 45 hospitals that were evaluated this round, one quarter saw their scores change one way or another. Two of Louisville’s four hospital systems saw their scores fall one letter grade to as low as a D, and none received an A.

Hospital reaction and criticism.
Hospitals that do well are happy. Those who do not may understandably make an effort to mitigate the adverse publicity. Jewish Hospital and St. Mary’s Healthcare (which received a D) raised an objection we have heard before– that the playing field is not level. Is it true that hospitals that do not participate with Leapfrog’s proprietary and totally optional hospital survey are at a disadvantage? Leapfrog says no– hospitals are not penalized for having empty boxes in the evaluation matrix. What happens is that all the other items (mostly obtained from the Medicare Compare database) are simply counted more heavily. KentuckyOne also argued that the data on which the scores are based is outdated.  (Who is to say that newer data will not be worse  than the old!)   I think both these arguments deserve consideration but in my opinion fail to explain the drop in scores for two Louisville Hospitals.  After all, only a handful of hospitals in Kentucky participate with Leapfrog. Whether a hospital benefits or not probably depends more on how good their performance on the survey is.  Yes, the data on which the scores are based will probably be more that a year old, but virtually all Kentucky hospitals are in the same boat with respect to timeliness of data and Leapfrog participation.  The Kentucky playing field, at least, is pretty level!  I will provide examples from selected hospitals to illustrate this discussion. Continue reading “Safety of Louisville Hospitals: Are we there yet?”

Leapfrog Hospital Safety Scores Released: Third Iteration.

mapMay2-13Doing not so good? Blame the test.

On May 8, the Leapfrog group released the third iteration of its Hospital Safety Scores. The first appeared in June 2012, and the second in November. I have expressed concerns about the value to curious professionals and consumers alike because of things like volatility of scores over the short term, lack of inclusion of the many small hospitals in the state, and lack of correlation with safety scores proposed by other organizations. Nonetheless, the Leapfrog Group was one of the earliest to push for public disclosure of hospital safety parameters and its evaluation deserves to be taken seriously. I will break out the data underlying the scores and compare it to last November’s in more detail later, but for the time being, here is a raw count of the results for Kentucky hospitals.

Continue reading “Leapfrog Hospital Safety Scores Released: Third Iteration.”

Objects Accidentally Left in the Body After Surgery in Kentucky

retained-itemRetained surgical objects:  A useful marker of hospital quality and safety?

A few weeks ago, the national newspaper, “USA Today,” reprinted a Courier-Journal exclusive by Andrew Wolfson about the phenomena of “angioplasty-abuse” prompted by a Kentucky lawsuit but increasingly evident nationwide. This week, the C-J returned the favor by running a shorter version of a piece by Peter Eisler of USA Today about “retained surgical items,” that is, the accidental leaving of foreign objects inside the body after surgery- usually in the abdomen or chest. Everyone has heard stories about surgical sponges or instruments left behind– perhaps to be discovered later when symptoms or complications occur. It is a medical mistake that is never supposed to happen, and a red flag that a hospital or surgical center may not have requisite safety procedures in place. Because of this, the frequency of retained items is included in most of the safety and quality evaluations of hospitals. That is what attracted my attention for this blog. Continue reading “Objects Accidentally Left in the Body After Surgery in Kentucky”