Hospitals lost ground in battle against infections during pandemic, new report says
During the pandemic, hospital patients in Northeast Ohio and across the country were more likely to acquire infections during their stay, a new health care safety report shows.
From 2021 to 2023, Ohio witnessed a nearly 91% increase in the number of bloodstream infections, a 61% increase in Methicillin-resistant Staphylococcus aureus infections (MRSA) and a 31% increase in urinary tract infections, according to a report by the Leapfrog Group, a nonprofit which tracks patient safety.
Nationwide, the average risk of the three healthcare-associated infections reached a five-year high during the pandemic and has remained at those levels, according to Leapfrog.
The reason for the negative trend during COVID-19 may be changes in health care processes at hospitals that took place during the pandemic, said Dr. Joseph Golob, MetroHealth’s Senior Vice President, Chief of Quality and Safety.
"Quality improvement and patient safety is all based on process. You've got to have [a] standardized process that people follow... and the hypothesis is that COVID changed these practices," he said. "We've got to... ensure we're getting back to that pre-pandemic state."
Leapfrog tracks infections and more than 30 other performance measures to assign grades to nearly 3,000 general acute-care hospitals in the U.S. twice a year.
Leapfrog researchers also look at avoidable errors, hand washing and other safety measures to grade individual hospitals on a scale of "A," the best, to "F," the worst.
Although Leapfrog data shows that many Northeast Ohio hospitals have improved since the early days of the pandemic, several in the most recent report received "C" grades for safety, the lowest grade received by any hospital in the region.
MetroHealth Medical Center, University Hospitals Elyria Medical Center, University Hospital Lake West Medical Center in Willoughby and University Hospital TriPoint Medical Center in Concord Township all received "C" ratings for 2023.
University Hospitals Ahuja, Geauga, Parma and Samaritan medical centers all received "A" grades, as did the Cleveland Clinic's main campus and Fairview, Lutheran, Marymount, Hillcrest and Southpointe hospitals. UH's main campus and the Clinic's Akron General earned "Bs."
The report is a wake-up call and an important tool to assess the quality of health care, hospital officials said.
"The degree of suffering and preventable harm in hospitals is real,” said Dr. Peter J. Pronovost, University Hospital’s Chief Clinical Transformation Officer and also serves on Leapfrog's expert panel.
Having plans in place to reduce hospital infections will “reduce those harms will improve, will save lives, reduce their suffering, and importantly, save money for patients and hospitals, because every one of these infections on average doubles or triples the cost of your care,” he said.
The report also rates hospitals on individual areas, which are combined to create the composite grades.
MetroHealth scored among the worst in the nation for "death rates resulting from treatable serious complications after surgery," the report showed. These complications can include patients catching pneumonia, having a heart attack or losing function in the kidneys or liver after surgery.
MetroHealth is examining how to improve the way it addresses those complications and other measures, Golob said.
“We initiated a new process that we are evaluating every single one of them, and we share those results through our patient safety team with the providers that are involved,” he said.
This analysis helps MetroHealth determine the root cause of a problem, according to Golob.
“It looks at the systems and the processes to identify system and process flaws that may be implicated as a potential cause of the event or the cause of the death,” he said.
MetroHealth began this assessment in March and expects to see sustained improvements in care from the change in a year, Golob said.
But Golob cautioned that of all the safety indicators, "death rates resulting from treatable serious complications after surgery" was among the most difficult to improve because many of the medical procedures in question are done to get a diagnosis and the patient many times dies from that same diagnosis.
Golob and other hospital officials expressed concerns about some of Leapfrog's methodology and standards used in the grading.
To receive a good grade for handwashing, he pointed out, MetroHealth would need to have people dedicated to observe handwashing or install a system to that counts the number of handwashing instances, which is very expensive.
"Do we believe handwashing is important? Absolutely," Golob said. "But the flaw in their methodology is how they're trying to measure that."
Pronovost, who also serves on an advisory group at Leapfrog, said UH plans to redouble its efforts to improve care at its hospitals that received “C” grades. The hospital system is addressing any problems by implementing improved processes to ensure better health outcomes, he said.
He added that two of the three hospitals that received "C" grades, Lake West and Tri-Point, are still being incorporated into UH's electronic medical records system, which will help them implement safety protocols.
“There's a kind of troubling realization that the efforts we make for safety are still largely based on the heroism of our clinicians remembering to do things rather than the design of safe systems," Pronovost said.
UH’s plan is to use electronic health records and training programs to implement safety systems throughout the hospital system, he said.
Nationally, Ohio hospitals ranked 26th in patient safety with nearly 27% of the state’s hospitals receiving an “A” grade in 2023, the data showed.