1. A well-known name doesn't guarantee low infection rates.
The Cleveland Clinic, part of a system of 11 hospitals in Ohio and Florida, is one of the most famous hospitals in the country. U.S. News & World Report consistently ranks its cardiology department No. 1 and many of its other departments in the top 10. Yet our analysis found that both the flagship hospital in downtown Cleveland and the system as a whole scored substantially worse than the national average for bloodstream infections in its ICUs.
We were able to analyze data from eight of the Cleveland Clinic's hospitals for 2009, the year with the most recent publicly available data. (The others either didn't report data or reported them in a way we couldn't use for our analysis.) Overall, they reported 143 infections in 48,184 days that their patients spent with central lines in place, a rate 41 percent worse than the national average. And at the flagship hospital, the infection rate in its medical-cardiac ICU was just average, while the overall rate in all of its ICUs was almost twice the national average.
Some hospitals in similar environments—notably Henry Ford Hospital in Detroit—did substantially better. Ford reported just 14 infections in 28,062 central-line days, a rate 78 percent better than average. And the Henry Ford Health system, with data from five of its six hospitals in Michigan, had an infection rate 73 percent lower than the national average, one of the best among any of the hospital systems we studied.
The Cleveland Clinic told us that in recent years it has taken several steps to improve bloodstream-infection rates, including frequent reviews of reported infections, participation in regional and national collaboratives to reduce infections, and the adoption of best practices in all of its hospitals. It says those measures have translated into substantial reductions in bloodstream-infection rates, which should appear in future publicly available reports.
2. Even good systems can have flaws.
Thirteen of the ones we looked at were able to reduce their number of bloodstream infections below the national average for each of their hospitals that reported data. But in many other systems, results varied considerably. For example, Kaiser Foundation Hospitals had an overall infection rate that was 36 percent lower than average. But its South San Francisco Medical Center had a rate almost three times higher than the national average. The nation's largest hospital system—the Hospital Corporation of America, headquartered in Nashville, Tenn.—had an infection rate close to the national average. But one of its hospitals, Lake City Medical Center in Lake City, Fla., had a rate 4.5 times higher than the national average.
"While some hospital systems are trying to solve the problem, patients still need to look at individual hospitals, not just systems," says John Santa, M.D., director of the Consumer Reports Health Ratings Center. "And hospital systems need to make sure the good changes they make at one hospital spread to every institution in their system."
3. Perfect is possible.
None of the hospital systems we analyzed reported zero bloodstream infections in all of their ICUs. But many of them did for at least one hospital. For example, two in the Henry Ford system—Henry Ford West Bloomfield Hospital and Henry Ford Macomb Hospital-Warren Campus, both in Michigan—reported none over a one-year period. And six Hospital Corporation of America facilities reported zero infections in more than 1,000 central-line days: Terre Haute Regional Hospital in Indiana; Garden Park Medical Center in Gulfport, Miss.; Research Medical Center in Kansas City, Mo.; Menorah Medical Center in Overland Park, Kan.; St. David's Georgetown Hospital in Texas; and St. Mark's Hospital in Salt Lake City.
Even some systems that did poorly overall had standouts. Two of the Cleveland Clinic's hospitals—Euclid Hospital in Ohio and Huron Hospital in Cleveland—reported zero infections, for example.
Overall, 23 of the hospital systems we looked at reported infection rates substantially better than the national average. "That's encouraging," says Lisa McGiffert, director of Consumers Union's Safe Patient Project. "It means that hospitals don't have to just live with high infection rates—and that patients don't have to put up with unsafe hospitals. Patients should look for hospital ratings that include safety and error rates. If hospitals don't report such information, patients should consider going elsewhere."