Being #1

Every year US News & World Report comes out with its rankings of best hospitals in the country and every year I read it with a grain of salt. My issue is not with the hospitals that are on the list. My concern has always been with the criteria that US News & World Report uses to evaluate hospitals and determine their ranked position.

During my years as a travel nurse I sought opportunities to work at many of these top organizations. I am able to honestly recognize the research that has been conducted at these hospitals and the amazing advancements in medicine that have been achieved. On the other hand patients die, medical mistakes happen, and diagnoses are missed at every organization in the country. Having a well-recognized name chiseled in stone above the entrance to your hospital doesn’t make it immune to those same challenges.

US News & World Report lists very clearly on their website the criteria they use for ranking organizations. Every year that the grading and ranking system goes unchanged; that which is most vital to excellent patient care and improved patient outcomes goes unrecognized and undervalued: nursing.

Directly from the US News & World Report 2012-2013 Best Hospitals Rankings; grading criteria:

Survival score (32.5 percent). A hospital’s success at keeping patients alive was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2008, 2009, and 2010—the three latest years for which data are available—with the number expected to die given the severity of illness. Hospitals were scored from 1 to 10, with 10 indicating the highest survival rate relative to other hospitals and 1 the lowest rate. Software used by many researchers (3M Health Information Systems Medicare Severity Grouper) took each patient’s condition into account.

Patient safety score (5 percent). Harmful blunders occur at every hospital; this score reflects how hard a hospital works to prevent six of the most egregious types. Injuries during surgery and major bleeding afterwards are two examples of the six categories of medical mishaps that were factored in. A hospital among the top 25 percent in this regard earned a score of 3, those in the middle 50 percent scored a 2, and those in the lower quartile scored a 1.

Reputation (32.5 percent). Each year, 200 physicians per specialty are randomly selected and asked to list the hospitals they consider to be the best in their specialty for complex or difficult cases without considering location or expense. To reduce the possibility that year-to-year shifts in physician perspective will skew the rankings, U.S. News each year bases the reputational score on the combined results of three years of surveys. The figure published for each hospital is the average percentage of specialists in 2010, 2011, and 2012 who named the hospital. (In the four specialties where rank relies only on reputation, hospitals were ranked if they were cited by at least 5 percent of physicians who responded to the most recent three years of U.S. News surveys.)

Other care-related indicators (30 percent). These include nurse staffing, technology, and other measures that have been found to be related to quality of care. The main source was the American Hospital Association’s 2010 survey of all hospitals in the nation.

Survival score and Reputation are tied in the grading system at 32.5% each? Reputation and patient outcome statistics are not the same thing. Reputation based on physician opinion is not a fair determinant. Physician practice does not equate to excellent hospital care and excellent patient outcomes. Stellar physician practice and skill is important for determining best physicians within a specialty, but not for determining the best hospital. Most patients learn very quickly that after surgery they see the physicians just daily: maybe. However you see the nurses constantly. To determine the best hospital you have to look at the care that happens within the hospital: that of which aligns directly within the scope of nursing practice.

A commitment to excellent patient safety is demonstrated in a hospital’s rates of blood-stream infections, falls, pressure ulcers, UTIs, and ventilator associated pneumonias.

Nurse to patient staffing ratios are a clear indicator of the value nursing care and patient safety alike carry within an organization. There is research study after research study that shows a clear correlation between higher patient to nurse ratios and less patient education impacting discharge and hospital readmission rates and greater numbers of hospital acquired injuries (pressure ulcers & falls) and infections (UTIs).

US News & World Report however lumps RN staffing ratios into the category “Other care-related indicators” along with technology and

“other measures that have been found to be related to quality of care”

Other measures “related” to quality of care????

Quality nursing care = Quality patient care

US News & World Report began ranking hospitals more than 20 years ago. Care has changed greatly and the way this magazine ranks hospitals should be challenged to adapt.

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