A national health care ranking organization has given Citrus Memorial Hospital its fourth consecutive B rating since the fall of 2017, making it one of the best-ranked hospitals in the area.
The Leapfrog Group, a nonprofit patient-safety organization comprised of a consortium of health care purchasers, issued Citrus Memorial its grade for patient safety this spring. The organization issues grades twice annually. The fourth B marks a significant turnaround since 2015, when Hospital Corporation of America began leasing the hospital. Earlier that year, Leapfrog issued Citrus Memorial a grade of D.
“It (the above average grade) says that we really believe in continuously improving what we do,” said Citrus Memorial Hospital CEO Ralph Aleman. “And we’re very close to being an A hospital, which is our goal.”
The only other area hospital that also managed a B was West Marion Community Hospital, also an HCA hospital, in Ocala. The grade was that hospital’s third consecutive B since 2018. Bayfront Health Seven Rivers does not participate in the Leapfrog survey and was not graded.
Leapfrog hospitals were graded in the areas of:
- Problems associated with surgeries
- Practices to prevent errors
- Safety problems
- Doctors, nurses and hospital staff
For infections, Leapfrog gave Citrus Memorial above-average grades for controlling patient MRSA infections, blood infections, infections in the urinary tract, and infections at the surgery site following colon surgery. The hospital received below-average marks for patient infection cases of Clostridium difficile. Most cases occur in patients taking antibiotics. It can cause diarrhea, abdominal pain, loss of appetite and fever.
Aleman said that the problem is that the hospital “does not do a very good job” documenting when patients come in with pre-existing infections. They are treated, but the pre-existing condition isn’t recorded for organizations like Leapfrog, which then dock the hospital for the infection.
For problems associated with surgeries, Citrus Memorial scored above average in not leaving a dangerous object behind after surgery, such as a surgical sponge, keeping surgical wounds from opening, ensuring surgical patients don’t develop breathing problems, and ensuring patients avoid accidental cuts and tears. But it received below-average marks for deaths from serious, treatable complications, incidents of collapsed lungs and patients developing dangerous blood clots.
Aleman said the Leapfrog evaluation is misleading here, too.
“We treat a very elderly population,” he told the Chronicle.
That means patients are more vulnerable if there are complications after surgery, Aleman said.
And that can be seen in the county’s overall high death rate — a reflection of so many seniors living in Citrus County, he said.
Citrus Memorial experienced 168.7 patient deaths for each 1,000 patients who experienced serious, but treatable complications after surgery in the hospital, according to Leapfrog. The national average score was 161.6 deaths.
The hospital received above-average marks for the safe administration of medication, staff hand-washing, and staff working together to prevent errors. But it failed when it came to doctors using computers to order patient medications, staff communicating with patients about the medicines they are taking, and communicating with patients about their discharge.
Citrus Memorial also performed well in restricting patient falls and injuries, reducing the cases of air or gas bubbles in patient blood, and tracking and reducing treatment errors. But it performed lower than average in preventing patients from getting bedsores.
Aleman again chalked that up to poor record-keeping when patients arrive with pre-existing problems. He said his hospital staff especially focus on avoidable problems, like bedsores, and added that people will see an improvement soon in the hospital’s Leapfrog scores.
The hospital received mixed reviews for its interaction with patients: above-average marks for effective leadership to prevent staff mistakes, enough qualified nurses, and specially trained doctors for its ICU patients. But it received below-average scores for patients’ ability to communicate with their doctors, nurses and the overall responsiveness of the hospital staff.
Aleman said that the patients’ poor reviews are not lost on him and communicating better is a priority with “courtesy and respect.”
“We’ve done a lot of coaching and training of our staff,” he said.
But changing human behavior is not easy, especially in the case of more than 300 doctors who work at Citrus Memorial but are not direct employees, he said.
That’s especially true for “overworked specialists” who are “pressed for time when they meet with patients,” he said.
He predicts Citrus Memorial’s next Leapfrog grade will be an A.
Other area hospitals included in the Leapfrog rankings included The Villages Regional Hospital, which received a C, Leesburg Regional Hospital, which received a C, Ocala Regional Medical Center, which received a C, and AdventHealth Ocala (formerly Munroe Regional Medical Center in Ocala), which received a D. The nearest A hospital was Oak Hill Hospital in Brooksville.
The Leapfrog Hospital Safety Grade is based primarily on measures collected and reported by the Centers for Medicare & Medicaid Services (CMS). The grade also includes data from a Leapfrog’s survey. If a hospital does not submit a Leapfrog Hospital survey, Leapfrog uses data from the American Hospital Association’s annual survey and IT supplement instead. Hospitals are not penalized for not reporting to Leapfrog.
A recent Leapfrog study shows the importance of selecting a good hospital.
The Leapfrog Group worked with the Johns Hopkins Armstrong Institute for Patient Safety and Quality to estimate deaths due to errors, accidents, injuries and infections at graded hospitals.
Leapfrog reported that researchers reviewed the data from more than 2,600 hospitals receiving Hospital Safety Grades and found that when compared to A hospitals:
- Patients at D and F hospitals faced a 92% greater risk of avoidable death.
- Patients at C hospitals on average face an 88% greater risk of avoidable death.
- Patients at B hospitals on average face a 35% greater risk of avoidable death.
Overall, an estimated 160,000 lives are lost annually from the avoidable medical errors that are accounted for in the Leapfrog Hospital Safety Grade, according to Leapfrog. But that is an improvement from 2016, when researchers estimated there had occurred 205,000 avoidable deaths.
Of this year’s grades this far:
- 32% earned an A, 26% earned a B, 36% earned a C, 6% a D and just under 1% an F
- The top five states with the highest percentages of A hospitals are: Oregon at 58%, Virginia at 53%, Maine at 50%, Massachusetts at 48% and Utah at 48%.
- There are no A hospitals in Wyoming, Alaska, Washington, D.C., Delaware or North Dakota.