VITAL SIGNS: Hospitals answer concerns after low accreditation ratings

      Five of Clark County's six acute care hospitals earned the lowest accreditation rating possible during surveys over the last three years.
      Since the accreditation decisions, several of the hospitals have raised their scores by addressing concerns raised by the Joint Commission on Accreditation of Healthcare Organizations. The original decision -- accredited with recommendations for improvement -- was given to all but one of the acute care hospitals in Las Vegas and Henderson.
      The recommendations rating -- the lowest of three accreditation levels -- is a common one, according to commission spokeswoman Alice Brown.
      "Seventy-five percent of the organizations we review actually do receive recommendations, meaning there have been deficiencies," she said. "What we require is that those improvements are made."
      Problems can range from paperwork documentation issues to the failure of a facility to train hospital personnel in effective infection control methods.
      But until recently, Clark County residents had no hope of obtaining specifics about the problems identified in the commission's surveys. Only the final accreditation decision was public record.
      The commission has fielded its share of criticism from Public Citizen and other groups, which charge that its focus on paperwork and procedural issues doesn't help consumers interested in mortality data, infection rates and other patient care indicators. But for Nevada residents, joint commission information is about the only independent data available.
      The commission has started releasing hospital performance reports, which provide the ratings used to compile the final accreditation score, Brown said.
      All the performance reports were supposed to have been available by January, Brown said. Now the target data is April. Locally, only the report for St. Rose Dominican was public as of early March.
      "We are used to getting answers about any product that we can purchase," Brown said, explaining why the reports will be public. "If you can get that information about a car, you should be able to get information about the health care you use."
      The Las Vegas and Henderson hospitals accredited with recommendations for improvement were Desert Springs Hospital, Lake Mead Hospital Medical Center, St. Rose Dominican Hospital, University Medical Center and Valley Hospital Medical Center.
      Columbia Sunrise Hospital and Medical Center received the highest level -- accreditation with commendation. Columbia Sunrise MountainView is still too new to undergo an accreditation survey.
      Several of the facilities have made changes since the accreditation decisions.
      Lake Mead Medical Center was downgraded to conditional accreditation after the commission surveyed the psychiatric portion of the hospital in the wake of a fire started by a patient. On March 6, the joint commission placed University Medical Center on a similar status, known as accreditation watch.
      The temporary designation is assigned after a serious incident causes injury or death. But the public won't be told the nature of the incident, even when the hospital's performance report is available.
      Bill Hale, the University Medical Center's chief executive officer, said the incident there "had nothing to do with the quality of care at this institution."
      The joint commission, Hale said, is examining the circumstances surrounding a patient's suicide. He declined to elaborate, citing patient confidentiality.
      The performance reports, once made public, provide the hospital's score in nearly 50 different categories, as well as comparisons with other hospitals nationwide. But the picture provided is still sketchy.
      For example, on the St. Rose report, the six areas recommended for improvement include medication use, implementation of safety plans and credentialing. The report showed the problems were remedied within six months, by December 1995, but do not detail the nature of the problems under each category.
      Rod Davis, St. Rose's chief executive officer, joined several hospital administrators who pointed out that recommendations can pertain to relatively minor items.
      For example, of the safety plans category, Davis said: "Everything passed completely except for one of our ambulatory centers away from St. Rose, (where) we are required to have X number of fire drills each year. We missed one fire drill."