UPDATE: In response to this story, Upper Chesapeake Health President/CEO Lyle E. Sheldon sent a letter to The Dagger’s Cindy Mumby indicating “The Analysis We have Done to Date Assures Us that This is Not a Quality of Care Issue”.
Sepsis infection rates reported at Upper Chesapeake Health hospitals in Harford County were among the highest in the state, according to a Maryland Health Care Commission analysis released Friday. Sepsis is a potentially fatal condition, and a leading cause of death in hospitals.
The analysis of sepsis reported in the fiscal year 2012 also identified a higher than expected number of hospital-acquired sepsis cases at both Upper Chesapeake Medical Center in Bel Air, and Harford Memorial Hospital in Havre de Grace. Both hospitals ranked among the top seven in the state for rates of hospital-acquired sepsis.
The Maryland Health Care Commission (MHCC) analysis did not identify causes for the high sepsis rates at the only two acute care hospitals operating in Harford County. However, MHCC Executive Director Ben Steffen reported on June 28 that Upper Chesapeake Heath had been apprised of the analysis and invited to respond. A spokesperson for Upper Chesapeake said late Friday that a response would be forthcoming early this week.
“Sepsis is a serious medical condition caused by an overwhelming immune response to infection,” according to the National Institute of General Medical Sciences Web site, which further describes the condition as follows:
“Immune chemicals released into the blood to combat the infection trigger widespread inflammation, which leads to blood clots and leaky vessels. This results in impaired blood flow, which damages the body’s organs by depriving them of nutrients and oxygen.
In severe cases, one or more organs fail. In the worst cases, blood pressure drops, the heart weakens and the patient spirals toward septic shock. Once this happens, multiple organs—lungs, kidneys, liver—may quickly fail and the patient can die.”
Every year, severe sepsis strikes about 750,000 Americans. It’s been estimated that between 28 and 50 percent of these people die—far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined.”
The Maryland Health Care Commission (MHCC) analysis was undertaken in response to inquiries from Bel Air resident Pat Lovett, who discovered what appeared to be high sepsis infection rates at the Upper Chesapeake Health hospitals, based on limited data available from a federal government Web site.
The MHCC analysis released Friday confirmed that the Upper Chesapeake Health hospitals had among the highest rates of reported sepsis cases in the state for the fiscal year 2012, based on 885 cases reported at Upper Chesapeake Medical Center and 346 at Harford Memorial. The rate of sepsis cases as a percent of total cases at each hospital was 5.87% and 6.14% respectively.
The vast majority of sepsis cases were not hospital-acquired.
According to the report by MHCC Executive Director Steffen, measuring hospital-acquired cases, or so-called PPCs (Potentially Preventable Complications), provides “a more accurate gauge of how a hospital, itself, is performing…”
In the fiscal year 2012, the number of such cases identified at the Upper Chesapeake Health hospitals (50 combined for both hospitals) was “higher than would be expected given the volume and patient mix” at Upper Chesapeake Medical Center and Harford Memorial, according to Steffen. He also cautioned that the number 50 was “not large”, and year to year variations in related rates “could be substantial.”
For hospital-acquired sepsis, MHCC considered the number of observed cases compared to expected levels, such that a ratio in excess of 1 was “undesirable”, according to Steffen’s report.
The ratios for Upper Chesapeake Medical Center and Harford Memorial Hospital were 1.74 and 2.29 respectively.
Both hospitals were also ranked among the highest seven hospitals in the state for their rates of risk-adjusted, hospital-acquired sepsis. For all Maryland hospitals in fiscal year 2012, the range was 0.00 – 8.41, with a mean of 2.90/1,000 persons at risk.
The rates at Upper Chesapeake Medical Center and Harford Memorial were 4.18 and 5.5, respectively.
MHCC also performed a broader study of hospital-acquired infections at the Upper Chesapeake Health hospitals, which included, but was not limited to, sepsis. That study determined the overall hospital-acquired infection rates were close to expectations at Harford Memorial, and lower than expected at Upper Chesapeake Medical Center. Referencing these overall hospital-acquired infection rates, Steffen wrote: “Globally, the Upper Chesapeake Health facilities do not appear to be sub-par performers in this area of patient care quality when compared with other Maryland hospitals.”
However, Steffen also wrote that MHCC’s “limited review of sepsis cases is worthy of additional consideration,” adding that the report was being shared with the Maryland Office of Health Care Quality, which is responsible for hospital licensure and quality of care investigations.
In response to an earlier request from The Dagger to review the sepsis data brought to light by Lovett, Martha Mallonee, Upper Chesapeake Health’s director of corporate communications, marketing and public relations, said in mid-June that an internal review was underway and the findings would be publicly reported when they became available:
At the time, Mallonee also offered a possible explanation for the appearance of high sepsis rates. In an email dated June 14, she wrote:
“We are currently undergoing an analysis (started before your inquiry) to determine if our rates reflect an actual higher incidence of sepsis or if the code ‘possible sepsis’ is not being updated in the record to reflect the final diagnosis before a patient is discharged. The definition of sepsis is not uniformly agreed upon and the coding is very much definition-dependent. We are reviewing both the documentation and coding to determine if there are any issues. We don’t believe there are quality of care issues.”
However, given the latest findings from MHCC, The Dagger contacted Upper Chesapeake Health on Friday, asking about the cause of the higher than expected, hospital-acquired sepsis rates, and what steps were being taken to protect patients at its two hospitals.
Ms. Mallonnee provided the following response:
“…we are in the process of developing some information for you and should have something to share early next week.”
Below is a copy of the MHCC report sent to Lovett, which was also provided by Executive Director Steffen to The Dagger upon request.