Confusion persists as attempts to rate hospital safety advance. (How Safe are L.A.'s Hospitals? - Health Care Special Report).

AFTER years of relatively little attention being paid to hospital safety, so much work is being done now that it's easy to be confused about the complex--and sometimes conflicting--findings.

An alphabet soup of organizations, both public and private, have their hand in developing measurements of hospital safety, as well as standards for improving it.

"There isn't enough good, solid evidence on what is effective in promoting safety," said Nancy Foster, the American Hospital Association's senior associate director for policy. "And there is no single effort I am aware of that gives patients the feeling they are getting the information they want."

There have been attempts over the years to quantify hospital safety. The Joint Commission On Accreditation of Health Care Organization, a nonprofit organization that accredits the nation's hospitals, has a database going back to 1995 of serious errors that occur in hospitals, such as surgery on the wrong part of a body, medication errors, delays in treatment and patient falls. But the reporting of such events is voluntary and even JCAHO admits it only catches a fraction of the cases. Moreover, the data is aggregated and individual hospitals are not identified.

More recently, there is the Leapfrog Group, a consortium of Fortune 500 companies and healthcare buyers with 30 million employees, which opened a Web site earlier this year that rated nearly 300 hospitals in six regions nationwide, including Los Angeles, on a set of quality and safety measurements.

The group determines hospital quality and safety by three measures: the use of specialists called "intensivists" in intensive care units, the use of computerized drug prescription systems, and surgery volume in six high-risk but common procedures, such as angioplasty. (Research shows that surgical outcomes are often better at hospitals that perform large numbers of procedures.)

Although the measurements are narrow, Leapfrog estimates some 60,000 lives could be saved and 500,000 drug errors eliminated if urban hospitals followed its standards.

In Los Angeles, the ratings show that only four hospitals staff their intensive care units with intensivists; two hospitals are beginning to. Also, only three hospitals have full computerized prescribing systems, five others have partial ones and one is beginning to work on one.

Among the top hospitals, according to these criteria, are UCLA Medical Center, Cedars-Sinai Medical Center and City of Hope Comprehensive Cancer Center. The measurements do not establish one rating for individual hospitals.

"The purchasers that launched Leapfrog did it to kick start the effort to create national standards," said Peter Lee, president of the Pacific Business Group on Health, a coalition of large health care buyers and leader of the California Leapfrog effort.

But the measurements have been challenged by the American Hospital Association, which notes the multi-million-dollar cost of computerized drug prescribing systems, while the federal Agency for Healthcare Research and Quality questioned the clinical evidence behind the measurements.

Even Lee acknowledges that Leapfrog is far from the ultimate in hospital quality and safety standards. Another group called the National Quality Forum is working on a far broader spectrum of more than 80 standards that it hopes to complete by the end of the year.

"Leapfrog focused on three things. What we were asked to provide is the all-inclusive list of what should be present," said Dr. Kenneth Kizer, chief executive of the forum.

Simple procedures

That list may incorporate Leapfrog's standards, as well as others--such as the recommendation that verbal medical orders be repeated back. "When you order fries it's done at McDonald's but it's not done when you are giving life threatening drugs," Kizer said.

And now the Joint Commission has recently pushed its own hospital safety agenda. It requires hospitals seeking accreditation to evaluate and change any weak internal systems--such as in the prescribing and delivery of medication--that may cause medical mistakes.

It also wants hospitals to encourage the reporting of mistakes internally so ways can be designed to prevent them, and to tell patients when they have been harmed by medical errors.

However, the Joint Commission has not budged on the idea of allowing public access to quality and safety data on individual hospitals, contending hospitals would be discouraged from reporting errors for fear of litigation.

"If you hang people and organizations out to dry you will never see the data," said Dr. Dennis O'Leary, president of the Commission.

Thomas Scully, administrator of the Centers for Medicare and Medicaid Services, a huge buyer of healthcare, has said he wants more publicly available data on hospitals.

The question now is how successful these efforts will be in improving hospital safety, especially if it involves voluntary compliance.

RELATED ARTICLE: Universal/Standard Safety Precautions for the OR

* Goggles/eye protection should be worn at all times while in the surgical suites.

* No recapping of needles.

* Use safety Pan when passing scalpels.

* Report all needle sticks/blood exposures to Employee Health (x3346) - seek treatment ASAP In Employee Health or Emergency Dept.

The OR supports our safety culture Please communicate any safety issues or concerns to the OR Managers.

Safety: Kaiser is posting reminders.