Pressure ulcer rates in Mass. hospitals posted online

Massachusetts hospitals today are revealing the rates of pressure ulcers their patients have acquired during their hospital stays, another in a series of statistics made public by the Massachusetts Hospital Association on its Patients First web site. Falls by patients in the hospital and nurse staffing plans were previously posted.

The data on pressure ulcers, better known as bedsores, was gathered on two days in March and September 2007 when nurses did full-body examinations of their patients. Pressure ulcers are a particular danger to certain patients, such as diabetics with circulation problems, paraplegics, or trauma patients immobilized on ICU ventilators.

Pressure ulcers are a good measure of nursing and hospital quality, Carol Haraden, vice president of the Cambridge-based Institute for Healthcare Improvement, said in an interview. The sores can become serious after skin breaks down from pressure, moisture, or abrasion, later destroying muscle and bone.

“In people who are prone to them, their ability to heal from them is often impaired,” making prevention critical, she said.

The hospital group took data from the state's 80 acute care, rehabilitation, and long-term acute hospitals and divided the reports by the units where patients were cared for: intensive care, “step-down,” medical, surgical, or medical-surgical units. Patients in step-down units require less monitoring than when they were in the ICU but more than in a regular bed.

The hospital rates are compared against state averages for hospitals of similar size and type, a way to account for how sick patients are, Karen Nelson, MHA senior vice president for clinical affairs, said in an interview. The measures follow criteria used by the National Quality Forum, a health-quality measurement organization.

For people using the Patients First site, it’s not easy to compare hospitals head to head, which is what the group intended, MHA’s Nelson said. Its goal is to encourage improvement by individual hospitals, although she conceded patients might want to see how hospitals rank.

“Going public with data like this, whether it's nurse staffing plans or falls or pressure-ulcer prevalence, is really to provide the public with the information about how hospitals are doing and shining a light on things important to patients and their families,” she said. “The other audience we also are looking at with this are the hospitals, so they learn from each other.”

The site shows significant variability among hospitals, but in most cases even sizeable differences in bedsore rates are not clearly statistically significant, according to an appendix to the hospital association report.

Only two hospitals had rates significantly above average, meaning they were truly performing worse than other similar-size hospitals, according to the website: 3 of 16 patients in the Athol Memorial Hospital medical-surgical unit had bedsores, or 19 percent; and 37 of 348 medical-surgical patients at St. Luke's Hospital in New Bedford had bedsores, or 11 percent.