Infection rates for 25 Dallas/Fort Worth area hospitals: Consumer Reports

Hospitals in the Dallas/Fort Worth area vary dramatically in terms of how well their intensive care units (ICUs) prevent central-line bloodstream infections, a cause of death, disability, and expense in our nations' hospitals that is largely preventable.  On February 2, www.ConsumerReportsHealth.org will post hospital infection rates for 25 Dallas/Fort Worth area hospitals along with other critical patient safety and satisfaction information for consumers.  Bloodstream infections cause at least 30 percent of the estimated 99,000 annual hospital-infection-related deaths in the U.S. and add on average $42,000 to the hospital bills of each ICU patient who gets a central line infection.

In the Dallas/Forth Worth area, only two of the 25 hospitals rated, Harris Methodist HEB and Harris Methodist Southwest, reported zero central line infections.  Other hospitals with lower than average infection rates include: Texas Health Arlington Memorial Hospital, which reported a rate that is 87 percent better than the national average, meaning there were 87 percent fewer infections reported than the U.S. average for its mix of ICUs; Baylor All Saints Medical Center reported 78 percent fewer infections than average; Lake Pointe Medical Center reported 73 percent fewer infections than average; and Baylor Medical Center at Irving reported 72 percent fewer infections than average.   The infection rates are for 2008.

On the other end of the spectrum, several Dallas/Ft. Worth area hospitals reported infection rates that were more than twice the national average: Methodist Dallas Medical Center reported an infection rate that was 192 percent worse than the national average for its mix of ICUs; Methodist Mansfield Medical Center reported a rate that was 159 percent worse than average; and Las Colinas Medical Center reported a rate that was 127 percent worse than average. Other hospitals that stand out for their poor performance include: Doctors Hospital at White Rock (77 percent worse than average); and Methodist Charlton Medical Center (69 percent worse than average).

In Dallas/Ft. Worth, variation among hospitals is true across the board and even within the same system of Baylor-owned hospitals and medical centers, which range from 78 percent better than average to 36 percent worse than average.  "Infection rates can vary widely from hospital to hospital and even within the same hospital chain or system," said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center.  "Providing patients with infection rate information enables them to identify which hospitals are making patient safety a priority and which ones are not."  According to a related investigative report in the March issue of Consumer Reports, of the 926 U.S. hospitals whose infection rates were analyzed by Consumer Reports Health, 105 hospitals tallied zero central line infections (listed online at www.ConsumerReportsHealth.org).  

"All hospitals should be aiming for zero infections," said Santa.  "The procedures needed to eliminate ICU infections are simple, low-tech, and inexpensive, requiring a change of mindset and culture. All ICUs should be able to dramatically reduce if not eliminate these infections," continued Santa.    

The Consumer Reports online ratings are based on hospitals that publicly report their infection rates as a result of state laws and hospitals that voluntarily report to the Leapfrog Group, a Washington D.C. based nonprofit, works with large employers and purchasers of health care to measure and publicly report on hospital safety and quality in 41 states in the U.S. (www.leapfroggroup.org).   Citizen activists, including those working with Consumers Union, the nonprofit publisher of Consumer Reports, have helped enact laws in 27 states, forcing hospitals to publicly disclose their infection rates.  To date, 17 of those states have made that information publicly available.  

There is an existing law in Texas requiring hospitals to report specific types of infections rates, including central line infections rates in ICUs. However, the law's implementation was delayed until funding was authorized in 2009.    

"Now that Texas has the funding it needs, the state should move forward with implementing its infection reporting law," said Lisa McGiffert, Director of Consumers Union's Safe Patient Project (www.SafePatientProject.org ).   "All Texans have the right to know whether their local hospital is doing a good job keeping patients safe from these sometimes deadly infections."

Consequently, the Consumer Reports ratings for Texas hospitals are based on Leapfrog data. "It is important to recognize that many hospitals demonstrate commitment to their communities by willingly reporting safety data—warts and all. Consumers should be most wary of hospitals that are asked to report by their patients, and refuse," said Leah Binder, CEO of the Leapfrog Group.   Binder noted that more than 40 hospitals in the Dallas/Fort Worth metro area declined to provide their data to Leapfrog during the reporting period.  A complete list of non-reporting hospitals can be found at www.leapfroggroup.org/decline.

A Central Line Associated Bloodstream Infection (CLABSI) is a type of infection caused by the presence of a central line catheter.   A "central line" or "central catheter" is a tube that is placed in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications.   These long, flexible catheters empty out in or near the heart so that the circulatory system can deliver what's put in them within seconds.  A bloodstream infection can occur when bacteria or other germs travel down the central line and enter the bloodstream, making the central line's biggest virtue as a quick pathway for delivering the essentials into its biggest vice.  

Since the risk of infection varies substantially across different types of ICUs, the Consumer Reports ratings are using what is known as a "standardized infection ratio," taking into account the unique mix of ICU types in a given hospital by comparing the hospital infection data for each ICU to the national average for each such ICU type published by the federal Centers for Disease Control and Prevention (CDC).   For instance, the average infection rate for cardiac ICUs nationwide is 2 per 1000 central line days (that's the total number of days that patients are on central lines), while surgical ICUs average 2.3 infections per 1000 central line days.  So an infection rate 100% above average would be 4 per 1000 days for a cardiac ICU, but 4.6 per 1000 days for a surgical ICU.