Death rate data raise eyebrows
Officials question some numbers and the interpretation of others
The Post and Courier
New government data places death rates at most of Charleston County hospitals well within the average, except for Trident Medical Center, whose rates were above average for Medicare patients admitted for heart failure.
But administrators and health experts say that patient choices and odd discrepancies make the regional numbers misleading.
The numbers released Thursday by the Centers for Medicare and Medicaid Services are based on patients discharged between July 2006 and June 2007 for three conditions: heart failure, heart attack and pneumonia.
Allison Walters, administrator of Trident's cardiovascular service line, said that of 255 Medicare patients treated for heart failure, 40 died.
Those who died of heart failure at Trident either had a do-not-resuscitate order upon admission or, during their stay, made their wishes known, Walters said. "Every single one of these patients were into end-of-life issues," she said. "We did a detailed review of every death we had. We did not find any care issues."
The numbers, which hospitals got to preview in May, surprised Walters because Trident currently doesn't have a system for tracking 30-day mortality rates, she said.
Medicare calculated the rates by comparing hospital discharge rates with Social Security death records. That means that if a patient is discharged after being treated for heart failure and dies for some other, unrelated reason within 30 days, that patient will be included on the hospital's mortality rate.
"It's information, but you have to be careful with that information," said Steven Shapiro, chief medical officer of Roper St. Francis Healthcare.
In the 30-day mortality measure for pneumonia, Bon Secours St. Francis Hospital, while not significantly different from the national rate of 11.4 percent, came in near the bottom of that average range at 8.4 percent and was among the lowest in the country.
Roper Hospital also boasted the lowest local mortality rate in heart attack and heart failure. Shapiro credited Roper Hospital's 63-minute average door-to-balloon time, which is the time from when a patient enters the hospital to the time he reaches the catheterization lab. The national average is 90 minutes.
Coming .2 percent behind Roper Hospital in the heart attack mortality measure was the Medical University of South Carolina, which has a door-to-balloon average time of 53 minutes, said Bill Spring, administrator for heart and vascular services at MUSC.
Lynn Bailey, a Columbia-based health care consultant, said she has doubts about the numbers.
The total number of Medicare heart failure patients for MUSC totaled 88, compared to Trident's 255 and Roper's 291.
"That doesn't make any sense," she said. "It makes me question the data of the whole region." Sometimes with large facilities such a MUSC, data may be reported by large sub-units, she said, but where to find an explanation is not easy.
MUSC's Spring was surprised by the discrepancy, too. "Heart failure is the No. 1 disease among Medicare recipients," he said.
Ultimately, the answer is with those at the Centers for Medicare and Medicaid who slice and dice the data, he said.
The S.C. Office of Research and Statistics, Health and Demographics reported that there were 800 discharges in Charleston County for Medicare patients with heart failure in 2006. The government data totals 762 for the period July 2006 to June 2007.
Dr. Rick Foster, vice president for quality and patient safety with the S.C. Hospital Association, said the low number of patient discharges recorded for MUSC could be related to how conditions are recorded at the hospital.
If heart failure is related to other conditions, the system may not be picking it up, he said.
Seeing outcome related measures, such as mortality rates, is a trend Foster expects will continue.
"In general, we're supportive of outcomes measures. It is still somewhat new territory," he said.
Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.
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Comments
This article has 14 comment(s)
Posted by Slick50 on August 22, 2008 at 4:56 a.m. (Suggest removal)
Finally, an area where Charleston is "above average".
Posted by DoaMM on August 22, 2008 at 8:03 a.m. (Suggest removal)
Don't ever take me to Trident. I have personal and professional experience with their staff and while they may not be completely incompetent, they certainly don't care much for a patient's problem.
That's just my opinion folks and your experience(s) may have been better, but the Trident health system is the last place I'll go for medical aid in the Low Country.
Posted by Paramount on August 22, 2008 at 8:11 a.m. (Suggest removal)
Look, the Trident bashing is underway. Not sure how that relates to the above article, but to each their own. I am more concerned about a government organization that presents erroneous data as fact. Most people will look at the above and trust that it is correct without even questioning where it came from. At least the Post and Courier is not as biased in this article as they usually are when it comes to healthcare news.
Posted by Paramount on August 22, 2008 at 8:32 a.m. (Suggest removal)
I am not sure if you know this, but ALL hospitals are in it to make money. With new construction from MUSC and future construction for both Roper and East Cooper, do you think they can just spend at will on everything. Every one of these institutions watch their bottom line and adjust accordingly. It is ignorant to think otherwise.
Posted by DoaMM on August 22, 2008 at 8:56 a.m. (Suggest removal)
CB, you are correct...to a point. The patient demographics may be a little different but "country tough" folks also emulate the lack of medical care, or lack of seeking medical care for that matter, of homeless people. The equation SHOULD work out for either a hospital located in Downtown Charleston or Trident's location, given the same number of patients (not just admissions).
Early, that could be.
Paramount, I'm not bashing Trident's equipment, procedures, or ability to save a life. What I'm bashing is their CONCERN for your welfare. They have shown me time and time again that they just don't care, sometimes about the most serious of patients. And no, I've never been a patient there.
Posted by Paramount on August 22, 2008 at 9:18 a.m. (Suggest removal)
Early, I don't know you, so asking me to trust your knowledge on anything is not going to happen. I understand the differences between the two and have worked in both types. In fact, I have spent most of my career in not for profit institutions so to assume I have no clue is a mistake.
You must realize that whether an organization is for-profit or not-for-profit, if it does not operate according to sound business practice and pay attention to the bottom line, it will not remain a viable business for a long enough period of time to fulfill its declared organizational mission.
Investor owned hospitals are better able to improve service through better facilities, more highly skilled staff, new and upgraded technology. They can do this due to their access to more capital.
Posted by jifdeng3 on August 22, 2008 at 9:21 a.m. (Suggest removal)
My wife is a nurse. I can tell you first hand that most of the staff at Trident hate working there because of how understaffed they are. Now go talk to the St. Francis nurses, who, for the most part love working there because the patient/nurse ratio is so low and they can actually take care of their patients.
Posted by DoaMM on August 22, 2008 at 9:32 a.m. (Suggest removal)
jifdeng3, the patient-to-nurse ratio is problematic and has shown to be a critical "patient relations" point with mega hospitals.
That being said, I don't care how bad of a day you are having as a nurse or doctor or how understaffed you are, you shouldn't let it show when you are in front of the patient. You went into the medical field for a reason...deal with it. If you don't like it, move to another hospital or get out of that field.
Posted by katrenavantassle on August 22, 2008 at 9:55 a.m. (Suggest removal)
I have a nephew who had a friend go into Trident Regional on Hwy 78 for a simple tonsilectomy. She was about 24 yrs old and in perfect health. After her surgery while in recovery, this poor girl started hemorraging in her throat and even with nurses checking on her they missed it and she DIED BY DROWNING IN HER OWN BLOOD!! (HER PARENTS SUED TRIDENT AND WON. GROSS NEGLIGENCE! STILL WON'T GIVE THIS GIRL HER LIFE BACK.) YET, MY OWN COUSIN came into Trident about 10 yrs ago with a broken neck, died 3 times and was saved by the great staff at that hospital then. But like all employees' people come and go...their are good and bad apples. Some nurses have such a disgruntled attitude and are so mean, and don't care if you report them. I wouldn't let them treat my dog, let alone treat me. Fill out the little cards and mail them. Don't drop them into the boxes for the staff to get out.
Health Care is a Million Dollar Industry. Doctor's go to 8 years (or more) of college and deserve to be paid for their knowledge and skills. Nurses go to college also and carry the brunt end of all the "BS" without the huge checks. Look at the statistics and you will see that all of America's hospitals are understaffed at one time or another and its the patients that always suffer. BTW, my daughter is a nurse. She is one of the good ones!
Posted by coolfreaknbeans on August 22, 2008 at 10:34 a.m. (Suggest removal)
I went into Trident last week to pick someone up.Upon walking into the ER I was instantly pissed.There was a poster size sign in SPANISH.To find the sign in English I had to walk to the other side of the desk.It took 10 minutes to be helped because the woman in front of me who was pregnant and had 3 kids with her-couldnt speak English.The ER was grubby and dirty looking.I got where I needed to be.The nurse told me we were waiting on blood test results.Well I noticed a tube of blood on the counter in the room.I approached the nurse and explained that the tube of blood was on the counter and she said "I know".Minutes later they released my friend with NO test results.Oh and to top it off they almost forgot to take her IV out.(they actually assisted her putting on her jacket right over the fn IV and I had to stop them!)Then they expected her to just walk herself out holding a barf bucket.BTW she was in there for repeated fainting and turning blue,taken in via ambulance.They sucked years ago and still suck.
Posted by DoaMM on August 22, 2008 at 11:36 a.m. (Suggest removal)
CB, the maternity ward is the best place to work in the hospital because everyone's so happy and cheerful for the "new arrival" and cutesie wootsie and so on and so forth.
Just don't EVER be a male up on that floor and piss off the nurses...EVER!
:)
Posted by ashleyatwork on August 22, 2008 at 1:52 p.m. (Suggest removal)
Wait till you get your bill from Trident, you will most probably be double billed for over half the items on it. Their billing department is dishonest and extremely rude.
Posted by eyfigueroa on August 22, 2008 at 4:35 p.m. (Suggest removal)
I've instructed my family that the only part of TRident to send me to is the morgue.
I've had terrible experiences from three (3) of their hospitals. My grandparents, great grand aunt, cousins, myself, my children, my mother. ALL of us with valid health insurance (no medicare or medicaid except for my grandparents). Every single one of us had terrible experiences. Misdiagnoses, long waits, rude staff, dismissive doctors and inaccurate billing. Both of my maternal grandparents deaths could be attributed to the horrific care given to them. (My grandmother in a semi-catatonic state was taken out of her bed so the linens could be changed. She was found slumped over NUDE in a chair with only a sheet to cover her. As my mother walked through the door she ran to catch her mother before she fell to the floor. All of this with a nurse and aide in the room) Trust me when I tell you that is tame compared to other episodes I can tell.
My mother many years ago started using St Francis, Roper and I use MUSC and the VA. My children have had care and surgeries through the old Navy Hospital and MUSC. All of us have had excellent results.
I cannot speak to the experiences of others, but for me and mine NONE of the Trident Hospitals or clinics are used by any of my ENTIRE family.
Call it bashing, I call it survival.
BTW, those stats are horrendous. Whoever they hired to do the analyses should be fired. Though not a fan of Trident, I have to agree that on the surface this report seems flawed.
Posted by jammer on August 23, 2008 at 8:39 a.m. (Suggest removal)
there's a note in my wallet, If taken to Trident DO NOT RESUSCITATE!!
I've known many that have worked at that hospital as well as others, you wouldn't believe the stories that come out...
the on going saying is you will either die or get the wrong organ removed if you go there
there are success stories out of there too of course or they'd already be shut down but I'm not rolling the dice
many bad things happen in there even to some of the people that work there as well as their families, I live within miles of there and only step foot in there to visit others... even one of my old boss's had a surgery gone wrong in there and his wife worked there for years, they knew the doc personally
I think it's the help more than the doc's, either way you won't find me in there for anything other than visiting others