Wednesday, May 25, 2005 | 11:01 a.m.
HCA Inc., owner of three Las Vegas hospitals, is spending millions of dollars to improve the quality of care it provides and to reduce medical errors and long-term costs.
The Nashville, Tenn.-based company owns Sunrise, MountainView and Southern Hills hospitals in Las Vegas and has implemented several patient safety and quality initiatives including barcoded prescriptions, sensors to prevent babies from being swapped or abducted and electronic prescription ordering.
Dr. Frank Houser, HCA's medical director and senior vice president of quality, was in Las Vegas on Tuesday to demonstrate some of the company's initiatives at its newest local hospital, Southern Hills, which was the first hospital built with the company's quality programs in mind.
HCA looked at ways to reduce medical errors after the Institute of Medicine came out with its 1999 report "To Err is Human," which said that medical errors are the No. 8 cause of death in the United States.
A national report released recently says medical errors and quality care are still a problem in many of the nation's hospitals but improvements have been made using programs similar to those used by HCA.
The study published May 18 in the Journal of the American Medical Association reported that computerized prescriptions reduced errors by 81 percent and team training in the delivery of babies reduced harmful outcomes by 51 percent.
Medication errors are the most common medical error so HCA implemented two programs to reduce those errors after conferring with hundreds of health care professionals nationally, Houser said.
For example, Southern Hills, like many of HCA's 190 hospitals, features an electronic medication administration record system (eMar) that requires nurses to scan a barcode on the patient's wrist and then scan the medication barcode before dispensing it. A wireless computer alerts nurses as to whether it is OK to give the medication to the patient after making sure it is the right drug in the right dosage for the right patient at the right time, Houser said. eMar also checks to make sure there are no drug interactions or patient allergies and that the dose is appropriate based on the patient's weight, he said.
HCA invested about $140 million for eMar, which should be installed in the remaining hospitals this year, Houser said.
In 2004, HCA measured the success of 116 of its hospitals that had used eMar for more than six months and found that out of the 51 million doses given, 1 million of them triggered warnings after their barcodes were scanned and those doses were not given, which means about 2 percent of the patients could have had significant problems, Houser said.
He said HCA hospitals prevented about 20,000 significant errors last year and expects to prevent 35,000 medication errors this year, which equates to a more than $50 million savings from reduced lengths of stay and complications.
In Las Vegas, the three HCA hospitals averted 13,647 medications from being wrongfully dispensed from January to March, which is about a 1.4 percent error reduction.
HCA anticipates a return on its investment within three years, Houser said.
The company is now focused on an electronic order entry that complements the electronic medication system and enables health care providers to verify that the medication is appropriate for the patient's diagnosis, he said.
HCA installed the order entry software in 12 of its hospitals, none of which is in Nevada, and expects to expand it to 80 hospitals this year at a cost of $80 million, Houser said.
Southern Hills does not have electronic order entry but it does have automated prescription software that enables emergency room doctors to type prescriptions, directions on how to the drugs should be taken and follow-up orders into a computer and print them so they are legible for patients and pharmacists.
The program, Script Rx, requires doctors to verify their identities with their fingerprints before they can access the system to print prescriptions and doctors' orders, which can be printed in English and Spanish.
Script Rx is coupled with the Picture Archiving Communication System that takes digital x-rays and enables doctors and radiologists to view the images from any of HCA's three local hospitals. Those combined systems can speed up the care process and makes continuous care easier for patients who live outside Nevada, said Amy Dirks Stevens, vice president of business development of HCA's Las Vegas market.
HCA corporate spokesman Jeff Prescott said the company is investing $250 million in the next five years to install the digital radiology services at all of its hospitals.
HCA has also implemented additional training in monitor reading for all of its obstetrics nurses. The Association of Women's Health, Obstetrics and Neonatal Nurses certification reduced HCA's obstetrics malpractice claims to slightly more than two claims per 1,000 live births in 2004 from an average of five and six claims per 1,000 live births from 1995 to 1999, Houser said.
Fewer obstetric malpractice claims enabled HCA to remove millions of dollars from its malpractice reserves, he said.
HCA has also implemented a program that minimizes the chances of babies being given to the wrong parents or abducted. The mother and child wear wrist or ankle bands with sensors that play a lullaby when the proper parent and baby are paired up, Southern Hills nurse Cathy Kelly said. Warning alarms sound if a baby is taken out of the obstetrics department or if its sensor is tampered with, she said.
Also all HCA nurses who have patients on telemetry monitors carry a pager that alerts them if the patient has a change in heart rhythm, removes the monitor sensors or encounters other complications.
The Centers for Medicare & Medicaid Services recently started paying higher reimbursements to hospitals that publicly report whether they meet certain industry-accepted quality standards for the treatment of heart attacks, congestive heart failure and pneumonia.
Also, some insurers link payments to providers' quality performances, which is an incentive for hospitals to improve their care to reap long-term benefits.
The Medicare reporting "will drive more toward outcomes and we'll be beautifully positioned," Houser said.
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