Play Live Radio
Next Up:
0:00
0:00
Available On Air Stations
KPBS Midday Edition

News In Numbers: Two San Diego Hospitals Among Worst For Deaths Of Hip Fracture Patients

An ambulance transports a patient to a San Diego hospital, March 27, 2016.
Megan Wood
An ambulance transports a patient to a San Diego hospital, March 27, 2016.
News In Numbers: Two San Diego Hospitals Among Worst For Deaths Of Hip Fracture Patients
News In Numbers: Two San Diego Hospitals Among Worst For Deaths Of Hip Fracture Patients GUEST: Cheryl Clark, reporter, inewsource

We all know that it is important for older people to take precautions to avoid hip fractures and to maintain their good health and mobility. If I hip fracture happens, it is also important to check the hip fracture mortality rates. According to numbers from the website two of the three worst hospitals in the state for hip fracture mortalities are in San Diego. They are Scripps Memorial in La Jolla and Kaiser Permanente San Diego Medical Center. Joining the Cheryl Clark. Welcome to the program. Thank you for having me. Why do people die from hip fractures quick Well, when they are taken to the hospital after a hip fracture this is an emergency and they are taken by ambulance. There are number things I happen. These are people who are already have problems with bone health. They have to arrive at the hospital and a team has to be ready to take care of them. They can develop pulmonary embolism and their heart may not be prepared for surgery. It requires a multidisciplinary team, which I told was one of the two most important things for hospitals to have on board. I will emphasize that what we are talking about with this measure of data is inpatient mortality. These are patients who went to the hospital after they fell and fractured her hip and did not get out of the hospital alive. These two hospitals have the highest rate of mortality for people admitted with hip fractures. How high was the percentage quick It was very high because the data who analyzed the statistics looked at how sick the patients were when they came in for instance, another hospital had 11% mortality rate but did not have a high mortality rate because presumably the patients who had hip fractures were a lot sicker and were older than they had been admitted from skilled nursing facilities whereas Kaiser Permanente had a foreign a half -- 4 and a half rate. That is a formula that went into -- That is the algorithm that they use to accumulate this data . This is Allstate data and reported to the state agency by hospitals. You spoke with orthopedic and hospital experts about the factors that lower the rates of hip fracture mortalities. What are some of those. I asked a number of surgical experts who get very excited about measuring quality of care and they have told me that the most important things are the speed of getting a patient into surgery and a multidisciplinary team to make sure that patients hearts are healthy enough that means a cardiologist have to be aboard and to know what the medications are what they react with each other and the medications that patients will be given in the hospital. They need to have a number of other people on board. I was told by Doctor Scott ball, which had no hip fracture deaths that surgery is really the least risky part. I think we have a clip. Your physical therapist is there and be mobilized. It's another really important piece of this, which more and more hospitals are funneling the patients outside so this does happen again because the next time it happens it's going to be worse and that means sending teams to patients homes and making sure that there are not any think they can trip on. These are things that people can understand. When we get older we still think we are invincible. So making sure that there's pads on staircases and making sure that patients exercise every day so that they can keep their balance and mobility as strong as possible. What do they have to say about these bad ratings? Their answers were different. Scripts said that they had a lot of senior patients coming in with hip fracture and some of them had requested that they not have surgery. They sent a comment letter to the state explaining that. Apparently it did not change the risk adjustment algorithm. Kaiser said that they were aware of the situation that they had instituted changes to their procedures and they assured me that their new data will reflect better outcomes. I've been speaking with Cheryl Clark. Thank you so much. Thank you, Marine.

News In Numbers: Two San Diego Hospitals Among Worst For Deaths Of Hip Fracture Patients
Among three hospitals in California with the worst rates of inpatient hip fracture mortality in 2014, two are in San Diego County.

With hip and knee surgeries growing across the country, measuring quality of care — especially survival — is increasingly important.

But among three hospitals in California with the worst rates of inpatient hip fracture mortality in 2014, two are in San Diego County: Scripps Memorial in La Jolla and Kaiser Permanente San Diego Medical Center, according to data from the Office of Statewide Health Planning and Development. The third is Santa Barbara Cottage Hospital.

The hip fracture death scores, available online, reflect care provided to the 2,566 patients in San Diego County who broke their hips in 2014, usually after a fall, most of whom were brought to an emergency room or trauma center. Hip fracture patients are generally older and have severe osteoporosis or bone loss.

The measure reveals the percentage of patients who did not leave the hospital alive and uses a formula that adjusts for patient severity to fairly account for hospitals that took care of patients who were sicker to begin with and more likely to not survive.

“We leveled the playing field with all of these hospitals as best we can with the risk models,” said Merry Holliday-Hanson, manager of the state health planning department’s administrative data.

The volume of hip fracture patients was high for both hospitals: 359 for Kaiser — which took in the most hip fracture patients of any hospital in the state — and 186 for Scripps Memorial.

All other hospitals in the county had “average” death rates for hip fracture patients except Palomar Hospital in downtown Escondido, which had an above average rating (Palomar is in the process of closing the downtown hospital and shifting services to the district’s other medical facilities.)

CalHospitalCompare also scores hospitals for patients who underwent elective hip or knee surgery for rates of readmissions and complications. Data for these measures are derived from the Centers for Medicare & Medicaid Services, which paid claims for surgical procedures performed on people who are 65 or older, blind or disabled.

Two key factors influence lower rates of inpatient death in hip fracture patients, said orthopedic surgeon Dr. Kevin Bozic, co-founder of the California Joint Replacement Registry who now chairs the department of surgery and perioperative care at Dell Medical School in Austin, Texas.

One, he said, is better patient management by a team that includes geriatricians, internists, nutritionists, orthopedic surgeons and pain management specialists who work well together and quickly when a hip fracture patient arrives. That is because hip fracture most often occurs when patients have osteoporosis and are often not ready for surgery.

“You need a team of people who are ready to go to manage their co-morbidities (other serious illnesses) and get them through surgery and recovery,” he said. Having a geriatrician, he emphasized, “is very, very important for this population.”

The second factor is speed.

“There’s pretty good evidence that patients with hip fracture who go to surgery within 24 to 48 hours of their arrival have lower mortality than patients who go to the operating room beyond that,” Bozic said.

Dr. Scott Ball, orthopedic surgeon at UCSD, which was reported as having no in-hospital deaths among its hip fracture patients, agreed with Bozic’s points on the necessity for a multidisciplinary team and rapid surgery as essentials for lower mortality.

A surgical team including Dr. Nikita Bezrukov, left, and Dr. Ian Foran, right, performs a hip procedure on a patient at UCSD’s Thornton Hospital, Feb. 3, 2017. Thornton Hospital is not among the worst for deaths of hip fracture patients.
Dr. Scott Ball
A surgical team including Dr. Nikita Bezrukov, left, and Dr. Ian Foran, right, performs a hip procedure on a patient at UCSD’s Thornton Hospital, Feb. 3, 2017. Thornton Hospital is not among the worst for deaths of hip fracture patients.

Ball added the importance of bringing cardiologists onto the team “to make sure the patient’s heart is healthy enough to undergo surgery,” as well as the “critical need” for appropriate use of anesthesia, good case management and physical therapists who get patients moving rather than just letting them lie in bed, which puts them at risk for pneumonia, bed sores and blood clots.

It is important to make sure patients with osteoporosis, who are at high risk for falling again, take appropriate medications “so you hopefully minimize the risk they ever have to go through this again.”

In response to the high hip fracture mortality data, Scripps officials deferred to a comment letter the hospital system sent to the state. It argued that a lot of patients who arrived for care after a hip fracture had endured a “serious traumatic fall.”

“Although supported by maximum appropriate surgical and medical therapies, many of these patients or their families had chosen palliative or comfort care prior to their deaths, which was honored by our facility,” the letter stated.

Kaiser officials said in an email that its hospital “has identified opportunities and taken measures to improve these outcomes, which have resulted in significant improvement in this area beginning in 2015. We expect the improvement to be reflected in future data released by OSHPD and CalHospitalCompare.”

Asked why Kaiser’s San Diego hospital receives more hip fracture patients than any other hospital in the state, a Kaiser spokeswoman said the region’s 600,000 enrollees make it the largest Kaiser system in California. Of those 600,000, about 90,000 are Medicare beneficiaries, which means they are 65 or older or blind or disabled.

More than 25,000 Californians endure a hip fracture every year and are rushed to hospitals for emergency care. Knowing which hospitals perform better at making sure they leave the hospital alive is a goal for all orthopedic surgery teams, Bozic said.

inewsource-foot-ermon-3.png