Quality of Care
All hospitals measure quality, but Catholic Health is the only healthcare system in Western New York that makes its quality data available directly to you and your family.
- Adverse Events
- Patient Safety Culture
- Patient Experience Overall Rating
- Patient Falls
- Pressure Ulcers (Bed Sores)
- Central Line Infections
- 30-day Readmissions
- Emergency Care
Adverse events are events or errors that can cause unintentional harm to a patient as the result of medical intervention, rather than the underlying medical condition.
Most adverse events are preventable. Preventable events can result from poor communication, a lack of safeguards or checkpoints, or human error. Failure to follow recognized, evidence-based best practices or guidelines at the individual or system level can lead to an adverse event.
At Catholic Health, when an adverse event occurs, we fully investigate the occurrence and complete a root cause analysis (RCA) in order to determine the attributing factor(s). Findings may result in a change to a policy or procedure and/or education for our associates and providers.
2015 Target: 0.51 significant events per 1,000 patient days
Preventing patient harm requires putting best practices into place. It also requires that a team believes in the importance of safety, that they talk to each other about safety awareness, and that they put into practice processes that will prevent harm to patients. Focusing on having a patient safety culture is linked to lower rates of nursing turnover, infections, pressure ulcers and other complications of care.
One way to learn about the level of patient safety culture at a hospital is to survey the staff that is working closest to the patients. Catholic Health has been participating in a survey created by The Agency for Healthcare Research and Quality (AHRQ) called Hospital Survey on Patient Safety Culture.
We use the comparative data to evaluate our efforts to establish, improve, and maintain a culture of patient safety in our hospitals.
The overall perception of safety measures how our hospital staff and physicians feel that we are doing at preventing errors from happening. A higher score indicates better performance.
Upon discharge from the hospital, a random selection of adult patients will be mailed a survey based on criteria set by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). The questions cover a variety of topics including: pain management, communication, cleanliness, quietness, responsiveness of staff, discharge planning, overall rating and willingness to recommend our hospitals.
The Overall Rating percentage includes only those patients that rated Catholic Health hospitals a top score of 9 or 10 on a 0-10 scale. A higher percentage is better.
Through our efforts to improve customer service, environmental and amenity issues, pain control and transition of care, we have achieved an improvement in our 2013 Overall Rating score.
2015 Target: Rating of 70.4% or higher
*State average based on fourth quarter 2013 through third quarter 2014.
While hospitals take precautions in preventing patient falls, they can occur for a number of reasons. Patients may be disoriented or have a weakened gait. They might not use the call button to ask for assistance, or a call may not be responded to immediately.
Fall prevention is a serious concern for all hospitals. By identifying patients at high risk for falls, providing timely risk reduction strategies and rounding frequently to address patient needs, Catholic Health aims to reduce fall occurrences.
2015 Target: Less than 2.49 falls per 1,000 patient days
The risk for pressure ulcers increases when patients are unable to shift their weight or move around independently. Prolonged pressure on certain areas of the body – often the heel, back and elbows – reduces circulation and cuts the supply of oxygen and vital nutrients.
Daily skin assessments, frequent patient repositioning, skin protection strategies and specialty beds have all helped to reduce the incidence of pressure ulcers.
2015 Target: less than 2.69%
A central line is an intravenous line/ tube that goes into a large vein in order to administer medications or withdraw blood.
Central line infections can be avoided by maintaining a sterile environment and frequent oversight to ensure the line remains clean and protected.
We have implemented evidence-based practices (also known as the Institute for Healthcare Improvement (IHI) Central Line Bundle) in order to reduce the risk of infection. Components of the Central Line Bundle include, but are not limited to, proper hand hygiene, sterile technique and daily assessment.
2015 Target: 0.43
State average is 2013 New York State average
30-day readmissions occur when a patient returns to the hospital soon after their previous stay. Better quality of care, thorough communication to the next transition of care and patient compliance with doctor instructions all can reduce the risk of a hospital readmission.
Catholic Health sees over 100,000 patients each year in its network of Western New York Emergency Departments.
Median Time from Emergency Department Arrival to When a Patient Was Seen by a Provider
*State median time based on fourth quarter 2013 through third quarter 2014.
Median Time from Emergency Department Arrival to Admission to the Hospital as an Inpatient
Often, patients must undergo extensive testing before being admitted to a hospital.
*State median time based on fourth quarter 2013 through third quarter 2014 discharges.
External reports from trusted sources demonstrate how we compare to other healthcare providers in Western New York and across the country.
- Hospital Compare - government website with quality data for over 4,000 Medicare-certified hospitals.
- Joint Commission - accredits / certifies hospitals nationwide
- The Leapfrog Group - allows you to search by city, state or hospital to see overall patient safety scores and scores for specific treatments, such as heart attack and weight loss surgery.