VITAL SIGNS: Push for disclosure gains some momentum

      Medical professionals who need surgery can turn to their colleagues for the inside scoop, said Cynthia Bunch, chairwoman of the economic and general welfare committee at the Nevada Nurses Association.
      "And it's a wonderful system," she said. But not, she added, for those outside the medical profession looking to find the best physician. "Really, consumers are at a disadvantage. As far as I know, there is nothing."
      The good news is that consumers are gaining some powerful partners in the push for public disclosure, said Lauren Dame, staff attorney with Public Citizen's Health Research Group. Employers who buy health care, as well as managed care companies, are demanding better measurements.
      "And people are getting smarter about what's worthwhile information," Dame said. "And they are not going to be satisfied by surveys conducted by a hospital of its own patients regarding, "Were you happy here?' "
      Few independent resources are available in Nevada, but residents should first talk to their family doctor, said Chris Thompson, chief of the state's health care financial analysis unit. Then, he said, they should not be shy about asking tough questions of hospital administrators.
      For example, a patient can ask hospital officials about death rates and complications related to a particular surgery, Thompson said. Keep in mind, he said, that the hospitals are self-reporting, so officials can use available data in the best light.
      "If they are not willing to give any information on it, I would take that as some sign of concern," he said.
      But hospital officials are reluctant to answer even basic questions, based on an informal survey of data conducted by the Review-Journal. Repeated telephone calls over the course of a week were required to obtain basic statistical information about patients and accreditation status from most facilities. Valley Hospital Medical Center, for example, took a week to respond.
      Columbia Sunrise Hospital and Medical Center was one of several hospitals that noted a question about the number of registered nurses per patient is not an accurate benchmark for quality. The number of registered nurses, spokeswoman Ann Lynch said, can vary widely between areas of the hospital. The intensive care unit, for example, would have more nurses per patient, she said.
      But prospective patients should still ask about particular units, said Bunch with the Nevada Nurses Association.
      "We have hospitals in town who have intensive care units that provide one-on-one staffing," Bunch said. "We have others that have three or four patients to one (nurse)."
      In four conversations, Diane Gregory, assistant administrator of physician services at Desert Springs Hospital, disagreed about the facility's accreditation level until finally confirming that Desert Springs was accredited with recommendations for improvement by the Joint Commission on Accreditation of Healthcare Organizations.
      The rating is the lowest of three accreditation levels. Desert Springs has since addressed the commission's concerns and its current status has been raised to the middle level -- known simply as accreditation.
      "If someone calls the joint commission and asks, their accreditation decision is accreditation with recommendations for improvement," spokeswoman Alice Brown said. "Although we would be quick to add that those improvements have been made in the case of Desert Springs."
      When patients do raise concerns, they often center more around aesthetics than the larger quality issues, said Karla Perez, chief operating officer at Valley Hospital Medical Center.
      "People typically don't come down to our administration and say, 'I want to know what your outcome is for heart attacks. They will say, 'My food is cold.' Or, 'The nurse didn't smile when she gave my medication.' "
      Prospective patients' questions should be specific, Bunch said. For example, chemotherapy or post-surgical patients would be more interested in infection control.
      "Because any time you have an open wound or a surgical incision, you have the perfect reservoir for infection," she said. "And if that bacteria is present in that environment you're in, you are at risk to pick that up through your wound or incision."