Measuring health care

By Marshall Allen

Wednesday, Dec. 6, 2006 | 7:09 a.m.

At the heart of the labor dispute at Desert Springs Hospital and Valley Hospital Medical Center is whether insufficient nursing levels are having an effect on patient care.

Each side in the dispute, which took a cooling-off turn Tuesday, is spewing rhetoric - nurses suggesting patients are in danger, hospital bosses saying patient care is good.

Rhetoric notwithstanding, there are measures of quality of care that suggest that Desert Springs and Valley are below average in patient care compared to other facilities in the county, state and nation.

The statistics are provided by hospitals and compiled by the Health and Human Services Department and the Joint Commission on Accreditation of Healthcare Organizations, a nonprofit group that accredits about 15,000 health care organizations nationwide.

The statistics are provided to increase accountability and help consumers decide where to get hospital services. Jane McAlevey, executive director of the 15,000-member Service Employees International Union Local 1107, which represents the nurses, said the poor indicators "are reflective of what the nurses experience every day." They are evidence that overworking nurses leads to poor care for patients, nurses say.

On its Web site, Desert Springs bills itself as the "heart hospital" because of its "solid reputation as a leader in cardiac care." But statistics gathered over a year by the government and the accrediting agency show that the boast may ring hollow.

At Desert Springs:

Desert Springs and Valley were ranked below all the hospitals in Clark County for the percent of heart attack patients given ACE inhibitors or ARBs - treatments that reduce risk of death from future heart attacks. Statewide, an average of 87 percent of patients received the treatments, but the numbers were only 75 percent and 77 percent at Valley and Desert Springs, respectively.

Valley's apparent shortcomings also were highlighted by the two agencies.

Ann Savin, system director for quality for the Valley Health System, which operates the two hospitals, says the numbers compiled by the government and joint commission are accurate, but "quality is very difficult to measure."

Nurses may give five instructions to heart patients being discharged, but forget to add the two that the indicators monitor, resulting in a poor score, she said. Or, doctors may not prescribe aspirin because it's available over the counter, she said, which results in poor marks.

Savin said there is no direct correlation between higher nurse-to-patient ratios and the quality of care, even though it makes intuitive sense.

"Sometimes we make more errors when we have more nurses on," Savin said. "They're distracted. They're talking among themselves."

Other health care experts say the numbers have their limitations. The chosen indicators are based on best practices and research, but quality of care is hard to quantify because it involves many moving parts.

Dr. Joe Heck, an emergency room physician and Republican state senator, said the statistics indicate shortcomings but do not explain why an outcome is lacking.