Copyright © 2020 Albuquerque Journal
So many University of New Mexico Hospital patients developed sepsis after surgeries in recent years that a federal agency in charge of compiling health data and ranking hospitals found UNMH to be one of the worst in the country for the condition.
Though the latest batch of data was updated last month, UNMH officials have known for years that they were struggling to keep patients from getting bloodstream infections after surgical procedures, said Dr. Richard Crowell, the chief quality officer for the UNM Health System.
“It’s been on our radar that we needed to improve,” he said. “It’s certainly something that we’ve known.”
UNMH had a “bloodstream infections after surgery” score of 9.21, which essentially reflects the rate of infection per 1,000 patients, based on data from 2016 to 2018 that was recently published by the Centers for Medicare and Medicaid Services. A Journal review of the data found that UNMH had the 10th-worst rate of any hospital in the country included on the CMS website and the worst rate in the state for post-surgery blood infections.
“If (infections) get into the bloodstream that’s a pretty severe infection,” Crowell said.
UNMH’s bloodstream infection rate also caught the attention of Becker’s Hospital Review, a prominent hospital industry magazine, which published a report last month finding UNMH was one of the 12 worst hospitals in the country for that type of infection.
On the other end of the spectrum, Lovelace Medical Center in Albuquerque, with a score of 4.2 per 1,000 patients, and Cristus St. Vincent in Santa Fe, with a rate of 4.41, were the best hospitals in the state for the rate of bloodstream infections after surgery, though many hospitals in New Mexico and around the country had “no data available” on the CMS website. Lea Regional Medical Center in Hobbs and Lovelace Westside Hospital also scored under 5 cases per 1,000 patients, according to the CMS website.
The bloodstream infection rate is only one of more than 100 measures that are tracked by the CMS. The data can be used to compare hospitals, and it can also affect Medicare and Medicaid reimbursements. UNMH was in line with national averages for many other measures.
But Dr. Vesta Sandoval, the chief medical officer of the Lovelace Health System, said the post-surgery bloodstream infection measure can be telling because it takes multiple levels of hospital employees – from medical technicians, nurses to physicians – to try to reduce a patient’s chances of developing a bloodstream infection and becoming septic, a life-threatening condition that can lead to organ failure.
“Of course it’s one piece of an entire puzzle … but it really speaks to a lot, because it takes into account the whole spectrum of care,” she said. “It takes … an entire team approach.”
To reduce the infections, Lovelace has put in place and then updated procedures for various types of monitoring before, during and after procedures. There are also regular reviews of policies governing the removal of indwelling lines – like a catheter or an IV – and getting patients moving after procedures, Sandoval said.
She said the CMS data shows the rate at which patients develop bloodstream infections and show symptoms, so it essentially is giving the rate at which patients become septic, she said. She said surgical site infections and bacteria entering the body through indwelling lines are common causes of the infections.
UNMH officials have said the complexity of their patients’ cases is one of the main reasons for their high infection rate. They downplayed the significance of CMS data and said it doesn’t speak to the quality of care provided at the hospital.
Crowell last week said he wasn’t aware of CMS data for UNMH’s rate of bloodstream infections after surgery and said the hospital uses other metrics to compare itself to peer hospitals. UNMH didn’t provide the Journal with that other data.
That said, Crowell said for about five years the hospital has been working to try to reduce its rate of bloodstream infections after surgery.
The hospital has reached out to national academic medical centers around the country, other hospitals in the state and hospital associations as UNMH worked to implement best practices in the industry, he said. Crowell said they’ve offered training within the hospital to try to reduce occurrences.
He said UNMH’s rate is poor, in part, because the hospital treats the sickest patients with the most severe illnesses in the state. Having conditions like cancer or diabetes, or if a person is malnourished or an alcoholic, can make someone more vulnerable to a bloodstream infection, Crowell said. UNMH is the only Level 1 Trauma Center in New Mexico, so many seriously ill patients are transferred there.
“People that have a lot of complicated illnesses can have a reaction that a person with fewer risk factors … might not have,” Crowell said.
At Lovelace, CMS data for various measures are woven into the culture of the hospital, Sandoval said.
“We’re constantly discussing data with physicians and other staff so everyone is aware where the hospital is on the spectrum,” she said. “It is very important to the culture of our hospital.”
Journal reporter Anthony Jackson contributed to this report.