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New York-area hospitals do poorly in patient safety

Consumer Reports rates hospitals in and around the Big Apple

Published: February 2012

Many hospitals in the New York City area do a poor job on four key measures of patient safety, according to a new Consumer Reports investigation. And almost all—including some well-known institutions such as Beth Israel Medical Center, Long Island Jewish Medical Center, St. Luke’s-Roosevelt Hospital Center, and Montefiore Medical Center—perform worse than most other hospitals around the country in our overall patient-safety score.

“New Yorkers often assume that they have access to some of the best health care in the world,” said John Santa, M.D., director of the Consumer Reports Health Ratings Center. “And in some ways they do, with many leading physicians and state-of-the-art facilities in the area. But our analysis suggests that, when it comes to patient safety, New Yorkers often receive sub-standard care.”

What we found

We looked at four key measures of patient safety: hospital-acquired infections, readmissions, and how well hospital staff communicate with patients about medications and discharge planning. We then combined those Ratings into an overall safety score.

“We chose those measures because they provide the best collection of data available on hospital safety, and provide a good picture of how committed hospitals are to protecting patients,” Santa said. He acknowledged that the patient-safety Ratings don’t tell consumers everything they need to know about a hospital. “But a low score, especially in multiple measures, is enough to raise a red flag,” he said.

Unfortunately for New Yorkers, most hospitals in the region—which includes New York City and adjoining communities in Westchester County, Long Island, and New Jersey—fared poorly on those measures.

Of the 50 lowest-scoring hospitals in our nationwide patient-safety Ratings, 30 are in the New York City area.

There are 1,045 hospitals in the country with data on each of our four safety measures. Of the 50 lowest-scoring such hospitals nationwide, 30 are in the New York City area. And 36 of the 81 hospitals in the New York City area with data in all four measures, or 44 percent, got our lowest or second-lowest Rating in each, compared with just 14 percent nationwide. (An additional 17 New York-area hospitals, including some well-known ones such as Lenox Hill and the Memorial Sloan-Kettering Cancer Center, did not have complete data in all four measures, and so are not included in our analysis.)

The best score from a New York City hospital, the NYU Langone Medical Center in Manhattan, was still 10 percent worse than the national average. For details, download our safety Ratings of New York City-area hospitals.

Only five hospitals in the New York area—and none in New York City itself—scored at or above the national average for all hospitals in our Ratings for all four measures:

  • St. Francis Hospital, Roslyn, N.Y.: 22 percent better than average
  • Peconic Bay Medical Center, Riverhead, N.Y.: 12 percent better than average
  • Saint Barnabas Medical Center, Livingston, N.J.: 8 percent better than average
  • Glen Cove Hospital, Glen Cove, N.Y.: 4 percent better than average
  • Robert Wood Johnson University Hospital, New Brunswick, N.J.: average

The five lowest-rated hospitals nationally, all in the New York area, were:

  • Jacobi Medical Center, Bronx: 68 percent worse than average
  • Nassau University Medical Center, East Meadow: 63 percent worse than average
  • Forest Hills Hospital, Queens: 62 percent worse than average
  • St. Joseph’s Medical Center, Yonkers: 62 percent worse than average
  • St. John’s Riverside Hospital, Yonkers: 62 percent worse than average

Hospitals respond

The hospitals offered various explanations for their poor performances. And it is true that the area’s large, urban population can pose challenges.

For example, patients at Jacobi Medical Center speak more than 150 languages, a spokeswoman for the hospital said. That might undermine its scores on communication about discharge and drugs, which are based on patient responses to a survey administered by the federal Centers for Medicare and Medicaid Services. In addition, the hospital sees mostly poor patients, many of whom suffer from substance abuse or mental illness and are uninsured, homeless, or live in shelters, all of which compromise their ability to receive follow-up care and increase the risk for readmissions.

Similarly, a spokesman told us that Forest Hills Hospital, part of the North Shore-Long Island Jewish Health System, “experienced significant improvement” despite the recent closure of several nearby hospitals, which put added pressure on it.

Santa, at our Health Ratings Center, agrees that those factors can make it harder for hospitals to provide high-quality care. “But they’re no excuse for being unsafe,” he said. He points out that other hospitals in the country and the region that serve similar populations do better. And some measures, like prevention of bloodstream infections in intensive care units linked to central-line catheters, reflect mostly staff performance, not patient characteristics. “No patient, no matter how poor, should put up with substandard care,” Santa said.

"No patient, no matter how poor, should put up with substandard care." — John Santa, M.D.

The hospitals also argue that the data in our Ratings might not be up-to-date. Jacobi says that its medical intensive-care unit, for example, has gone nine months without a central-line bloodstream infection and that its surgical unit has gone 12 months without one. But the most recent publicly released federal data shows that the hospital’s overall bloodstream-infection rate was 45 percent worse than the national benchmark during the first three months of 2011.

Forest Hills Hospital says that its bloodstream-infection rate falls within the reported margin of error for average. But the most up-to-date data available for the hospital show it is still worse than average, with an overall bloodstream-infection rate 48 percent worse than the national benchmark in the first quarter of 2011.

Similarly, relatively few intensive-care patients at St. Joseph’s Medical Center in Yonkers received central lines in 2010, a spokesman said, making it unfair to measure the hospital’s bloodstream-infection rate. But our analysis shows that in 2010 St. Joseph’s reported four infections in just 436 days that patients were on central lines. That earned it our lowest Rating on that measure, because of the high number of infections despite the low number of central-line days.

How hospitals can improve

Hospitals can do better, even in New York. For example, 36 hospitals in the New York City area that participated in an infection-prevention program between 2005 and 2008 cut their rate of bloodstream infections by an average of 70 percent. And 22 of them have infection rates below the average in our most recent Ratings.

One of those hospitals, Beth Israel Medical Center, in New York City saw its rate of bloodstream infections drop from 3.8 per every 1,000 days a patient was on a central line to 0.9 infections. It now rates 48 percent better than the national average on that measure.

Brian Koll, M.D., medical director at Beth Israel and chief of infection prevention, says the hospital is involved in another initiative, the Partnership for Patient Safety, that hopes to reduce bloodstream and surgical-site infections, as well as infections linked to urinary catheters, ventilator-associated pneumonia, and readmissions. Another program starting in several areas hospitals, Project RED, also aims to reduce readmissions.

To its credit, Jacobi Medical Center has signed up for both. It has also invested in a simultaneous translation system to meet the needs of its linguistically diverse population.

Other hospitals say they, too, have taken steps to improve. A spokesman for St. John’s Riverside Hospital in Yonkers, for example, says that a new administration has “introduced new strategic initiatives” aimed at reducing infection rates. And Forest Hills Hospital was the “first non-profit hospital system in New York State to post this data on our website,” a spokesman says, which reflects the hospital’s commitment to safety.

Sharon Silow-Carroll, a health-policy analyst at Health Management Associates in New York City, a consulting and research company that serves public and private health-care systems, says there are a lot of simple steps hospitals can take to reduce readmission rates. They include asking patients to repeat medication and other discharge instructions back to nurses and doctors, and keeping a white board in the room to help the patient and family prepare for discharge.

She also points out that new Medicare rules might prompt hospitals to speed up their efforts. That’s because under those rules, Medicare will penalize hospitals for preventable readmission. But, she says, attempts at improvement work only when the hospital leadership commits to change—something she says that too few hospitals do.

What you can do

If you live in the New York City area, you can use our hospital safety Ratings to see how good hospitals in your community are at protecting patients. If possible, choose a high-scoring hospital. (Download our safety Ratings of New York City-area hospitals.)

But even if you don’t have a choice, the Ratings can help you determine how vigilant you need to be when you enter the hospital. And regardless of how a hospital fares, everyone should take the following measures when they or someone they care for is in the hospital.

To prevent infections, take these steps:

  • Ask the hospital staff how they prevent bloodstream infections in intensive-care units, such as using a checklist to standardize insertion and maintenance practices for central lines. And find out what you can do to help monitor the line.
  • Make sure that all hospital staff and all visitors wash their hands with soap or an alcohol-based solution before touching a patient.
  • Ask whether central lines and urinary catheters are needed. They should be removed as soon as they're no longer necessary.
  • Before surgery, discuss any health conditions, such as diabetes, that might make you prone to infection. Stop smoking, because it also increases your risk. Don’t shave near the infection site. Ask whether you need antibiotics before your surgery. Make sure you understand instructions for caring for your wound before you go home. If you notice redness and pain at the surgery site, drainage, or fever, call your doctor.

To reduce readmissions, make sure you know the answers to these questions before you leave the hospital: 

  • How will you get home and to follow-up appointments?
  • What medical supplies do you need, such as oxygen or a cane or walker? What about home-health services? Will your insurance cover the cost?
  • Do you need to follow a special diet, or do special exercises.
  • Which doctor will you follow up with, and when are your appointments?
  • What family member or friend can you call on for help when you get home?

To prevent medication errors, make sure you know the answers to these questions before you take any medication given to you in the hospital or prescribed when you leave:

  • What is it, and why is it necessary?
  • How should you take the medication? How often should you take it?
  • What are the possible side effects, and what should you do if you experience them?
  • Can you have your prescription refilled when you leave the hospital?
  • What foods or over-the-counter medications do you need to avoid?

Read more about how to stay safe in the hospital.

Safety Ratings for New York-area hospitals

Our safety Ratings of New York-area hospitals are based on four key measures. Download our hospital-safety Ratings.

Hospital infections. This is based on data that hospitals submit to New York, New Jersey,  or the Leapfrog Group, a nonprofit organization that collects information about individual hospitals, on the two most common and potentially deadly hospital-acquired infections. Those include central-line-bloodstream infections, which are usually caused by a mishandling of the catheters used to deliver fluids, medication, and nutrition to patients in intensive-care units; and surgical-site infections, which are infections that occur within 30 days of certain surgical procedures or, in the case of implants, within a year. The Rating reflects the worst of the two scores.

Readmissions. This is based on billing data analyzed by the Centers for Medicare and Medicaid Services. A hospital's readmission Rating reflects the likelihood that a patient hospitalized because of heart attack, heart failure, or pneumonia will have to be readmitted to a hospital within 30 days of his or her initial discharge. The need for such readmission can indicate that a patient may have been sent home too early or wasn’t given appropriate discharge instructions or follow-up care.

Discharge instructions. The Rating on discharge instructions is based on a survey, the Hospital Consumer Assessment of Healthcare Providers and Systems, that hospitals are required to ask a sample of patients and then report to the Centers for Medicare and Medicaid Services. We looked at the percentage of patients who said they were given clear information before going home, such as what symptoms to watch out for and what kind of medical help they might need once they got home. Such steps can reduce the risk of readmissions.

Medication instructions. The Rating on medication instructions is based on the same survey as for discharge instructions. We looked at the percentage of patients who said they were told the purpose of the drugs they were prescribed while in the hospital and the possible side effects. Poor communication can increase the risk of drug errors, one of the most common causes of mistakes in the hospital.

Hospitals without enough data to rate

Seventeen New York City-area hospitals didn’t have complete data on all four of our safety measures, so they aren’t included in our Ratings. Lenox Hill Hospital, for example, has formally contested its scores on communication with patients about discharge and medications with the Centers for Medicare and Medicaid Services. Instead, we are showing their scores only on the measures they do report and are listing them alphabetically. Download a list of 17 New York-area hospitals that don't have enough data to rate.

   

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