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New Hampshire hospitals report decline in adverse events

  • FILE-In this May 17, 2011 file photo, the Dartmouth-Hitchcock Medical Center is seen in Lebanon, N.H. The Dartmouth-Hitchcock Medical Center is planning to construct a 116.5 million medical research center. The idea is to bring research from Dartmouth's medical school closer to the doctors who can use it to treat patients.(AP Photo/Toby Talbot) Toby Talbot

Monitor staff
Published: 11/25/2016 11:35:28 PM

New Hampshire hospitals reported 64 adverse events last year – also known as “never events,” because they are never supposed to happen.

The latest number marks a 12 percent drop from the 73 events reported in 2014, which state health officials say is a promising decline.

Events include falls, bedsores, foreign objects accidentally being left in patients after surgeries or doctors performing a procedure on the wrong body part.

But the data does not record information about mainline infections that can occur when intravenous tubes used to deliver medications, fluids and nutrients to patients transmit bacteria.

Some health experts say the state’s report is not the best indicator of hospital safety measures because it has different definitions for what constitutes a serious adverse event than the hospitals do.

Furthermore, each hospital may have its own rankings and definitions for how serious an incident is.

“There’s not a lot of guidance given,” said Lori Key, director of quality assurance and safety at Dartmouth Hitchcock Medical Center in Lebanon, who also chairs the quality commission reviewing adverse events reports.

“It becomes a game of does this meet the reporting requirement or not because there’s so much ambiguity,” Key added.

Dartmouth-Hitchcock, the state’s largest hospital and the one that takes the most complex cases, had the most adverse events – 16 total. Half of those events were related to patient bedsores, according to state data.

After Dartmouth-Hitchcock, the two other largest hospitals in the state reported fewer incidents. Elliot Hospital, with 266 beds, and Catholic Medical Center, with 240 beds, each reported four events. Both hopsitals are in Manchester.

Dover’s Wentworth-Douglass Hospital, with 114 beds, reported 6 events.

Dr. George Blike, chief quality and value officer at Dartmouth Hitchcock, said it is important to consider the size of the hospitals when looking at the number of events reported.

“Comparing us to a community and critical access hospital wouldn’t make much sense we’re doing very different work,” he said.

Key and others at Dartmouth-Hitchcock have worked to develop a scale to assess how serious an adverse event is. Of the 16 events the hospital reported to the state, she said 15 were “temporary and minor.”

The state’s data on hospitals also does not include data on mainline infections of patient IV tubes.

A recent investigation by Consumer Reports found many of the nation’s hospitals need to do more work to prevent bacteria from building up in the IV tubes used to deliver patients fluids, nutrients and medication. Preventing them is a serious business, because bacteria can be transmitted directly into a patient’s bloodstream if a line is infected.

In 2015, Dartmouth-Hitchcock reported 21 bloodstream infections, 12 surgical site infections and 15 catheter-associated urinary tract infections in 2015 – all better than the national rates for similary sized hospitals, according to Consumer Reports.

Key and Blike said the hospital has been making a concerted effort to reduce the number of mainline infections in the past year, after Consumer Reports data found put in the nation’s lowest-scoring hospitals for mainline infections.

Over the last 15 months, the hospital has seen a 70 percent reduction in central line infections, in part by reducing their use of peripherally inserted central catheters – also known as PICC lines.

PICC lines are long, thin tubes that are inserted through a vein in the arm, long enoguh to reach a larger vein close to a patient’s heart.

Hospital staff used to use the lines frequently to give patients nutrients and medicine, but can also be problematic if they become infected.

“I don’t think people were appreciating the infections that were going on with these lines, we certainly didn’t,” Blike said.

They have tried to cut down on infections by using fewer lines and trying to minimize the number of times they draw blood – the less likely blood gets in the lines, the less likely they are to become infected, Blike said.

“We did almost like Toyota production on the insertion room,” with better sterile conditions, equipment, training and dressing changes, he added.

As for the adverse events that grab headlines, such as the wrong body part being operated on – Key said that while those instances are serious, they are also very rare.

“They are big headline things because it’s so incredibly rare that level of mistake is made,” she said. “They are really complicated cases, often people with bilateral conditions.”

Blike and Key said their goal is to make sure all hospital staff are on the same page with safety protocol, in an attempt to reduce the number of infections and any other adverse event, whether it’s checking in with staff to see what the needs are or doing more rounds to make sure patients are comfortable.

“All of the things that we report to the state are certainly things we want to work on,” Key said.

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)

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