INSTITUTIONAL PATIENT SAFETY LEVELS AMONG THE HEALTHCARE'S “MOST WIRED” HOSPITALS
Feliciano B. Yu Jr., MD, MSHI, MSPH and Thomas K. Houston, MD, MPH. University of Alabama at Birmingham, Birmingham, AL
Purpose: To assess differences in objective patient safety indicators among hospitals labeled as “Most Wired” versus hospitals without that designation. Methods: Our main independent variable, Most Wired Hospital, is defined as a hospital or a member hospital of a health system listed among the Health and Hospital Network's (H&HN) 2001 Healthcare's 100 Most Wired Hospitals. Risk-adjusted Patient Safety Indicators (PSIs) were calculated using the Agency for Healthcare Research and Quality's (AHRQ) PSI Software version 2.1 for all 558 general adult medical/surgical hospitals participating in the AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database (2002). We first calculated a performance benchmark for each risk-adjusted surgical, medical and obstetric PSIs, identifying top performing hospitals using the Achievable Benchmarks of Care (ABC). We compared the proportion of Most Wired and comparison hospitals achieving each patient safety benchmark and then further compared mean risk-adjusted PSIs among the two hospital groups using chi-square and t-tests. Results: Sixty-three of the 558 NIS (11.2%) hospitals were “Most Wired” hospitals. A lower proportion of Most Wired hospitals performed at or above the top performing benchmark for 7 out of 11 surgical and for 1 out of 4 obstetric patient safety indicators, when compared to comparison hospitals. For example, only 32% of Most Wired hospitals met the calculated benchmark (risk-adjusted rate of 0.425 per 10,000 discharges or less) for “Complications of Anesthesia”, compared with 50% of other hospitals (p = 0.005). We did not detect any pattern of differences by “Most Wired” status for medical PSI calculated benchmarks. No significant differences were noted between Most Wired and comparison hospitals when compared using the mean risk-adjusted PSI rates. Conclusion: Our study show that hospitals affiliated with the “Most Wired Hospital” label did not out-perform other hospitals without the designation using objective institutional measures of patient safety.