AHCJ’s New Hospital Inspection Site Shows Medicare the Way Forward

It’s one thing to stick a bunch of documents on a website. It’s another thing to make good sense of them.

I praised AHCJ on Monday for making federal hospital inspection reports more widely available on HospitalInspections.org. The fact that AHCJ had to go this route begs the question of why this information isn’t already available on Medicare’s Hospital Compare site. For now, people interested in a hospital’s performance and quality will have to use both sites. Because I have encouraged health writers to think a little more like car writers, I took them both on a comparison test drive. The results are below:

Localization: If you are looking for information about a hospital – whether you are a reporter or a patient – you want to be able to quickly find out about the hospitals nearest you. CMS’ Hospital Compare allows you to type in a zip code and see all the hospitals within a certain range, and it does some of the thinking for you by adjusting the range based on the concentration of hospitals in your area. When I search for hospitals in 59401 – my home town of Great Falls, Montana – Hospital Compare returns 11 hospitals within 100 miles. If you think 100 miles is too far to drive for medical care or anything else, you haven’t lived in Montana. When I switch to my more recent neighborhood of Santa Ana, California, though, and type in 92701, Hospital Compare returns hospitals – 37 of them – within a tighter circle of 25 miles. AHCJ’s HospitalInspections.org only allows you to see hospitals at the state level.

Advantage: Hospital Compare.

Searchability: Databases can overwhelm. One of the best things about both of these tools is that they synthesize the information for users and present it in a fairly intuitive way. HospitalInspections.org allows you to search by key words, but Hospital Compare does not. You can do it by state or for the country as a whole. When I plugged in “infection” for the country, I received 295 reports. Great start. Then I typed in “MRSA,” and received a shorter list: 18. The first one was Iroquois Memorial Hospital in Watseka, Illinois. The hospital has been cited for 24 violations since 2011 in two different inspections. The most recent was from December 2012, and it shows that the hospital found out about a MRSA infection in March 2011 but did not document what it did about the infection, if anything. A patient was admitted and underwent surgery for a hernia and small bowel obstruction in February 2011. He was then readmitted to the hospital where a lab test showed “MRSA, Pseudomonas Aerugnosa." The report says:

There was no documentation to indicate when the culture was done. It indicated the Hospital was notified of the infection on 3/1/11. Notification was sent to the surgeon on 3/16/11 for follow up. The surgeon response was received on 4/10/12, was sent to the Committee member for review on 7/02/12, and as of 12/14/12 … the "Reviewer Findings" are listed as "pending". This is 21 months post notification of the initial infection occurring with no final response.

Advantage: HospitalInspections.org

Visual Appeal: Hospital Compare provides maps of hospital locations, graphs of the data, and lots of icons and visual cues to guide users through different aspects of the site. When Hospital Compare adds a new feature, for example, it tags it with a helpful little flag saying “new.” This is a small detail but enormously important for people like me who go there regularly and don’t want to keep reviewing the same information over and over. HospitalInspections.org provides just straight text, boxes, and hyperlinks. I praise the simplicity for other reasons later in the review, but for visual appeal, the site’s look does not invite users to spend much time there.

Advantage: Hospital Compare

Time-to-Enjoyment Ratio: The flip side of that super simple design is that HospitalInspections.org is also super simple to use. Hospital Compare has grown over the years, adding content and new features that regular users of the site appreciate and enjoy. But if you are coming new to both sites, you will likely find HospitalInspections.org easier to use. It provides what you are looking for more quickly and allows you to get where you want to go faster. One of my favorite aspects of the site in this regard is the way it breaks out the violations. These inspection reports can be long. One for Southern Virginia Regional Medical Center stretched to 6,257 words. HospitalInspections.org compiles the violations into a neat list that you see when you click on the number. Then, when you click on any of the violations themselves, it takes you to the relevant part of the report. Click on “Patient Rights: Personal Privacy,” for example – and who wouldn’t? – and you find out that Southern Virginia Regional was doing things that would make UCLA’s privacy violators blush.

Mounted on the wall across from the nurses station in a public hallway and between two patient rooms was a lighted electronic board. The ED nurse assisting with the tour referred to the board as the "ProMed Board." When asked to explain what the board was the ED nurse replied, these are all of our patients being treated here in the ED. She then continued to explain that this, pointing to the board, is the room number, patient's name, age, sex and status of tests ordered. When asked by this writer if this (meaning the board) compromised a patient's privacy the nurse replied, I guess so but we can fix that.

On 6/27/12 beginning at 9:10 A.M. another tour of the ED was conducted. The "ProMed Board" on the wall across from the nurses station in the public hallway was observed again. The board listed four patients that were in the ED being treated. No changes to the board appearance had occurred. The board listed all four patients last name, their room number, age and sex.

Upon leaving the ED, the Director of the ED and the Director of QA acknowledged the board provided identifiable information about who was being treated in the ED and failed to ensure a patient's right to privacy.

Advantage: HospitalInspections.org

Did you find something interesting at either site? Let me know. I’d love to write about it. Write askantidote@gmail.com or find me on Twitter @wheisel.