Jacobi Medical Center in the Bronx.

The New York State Nurses Association (NYSNA) has deplored the latest Consumer Reports survey ranking several New York City hospitals as among the worst in the nation when it comes to patient safety.

Of the 1,045 hospitals evaluated by the magazine out of more than 4,000 hospitals across the U.S., 30 in the metropolitan New York area landed in the 50 lowest-scoring institutions, with Jacobi Medical Center in the Bronx rated as the worst nationwide.

Some well-known New York institutions such as Beth Israel Medical Center, Long Island Jewish Medical Center, St. Luke’s-Roosevelt Hospital Center, and Montefiore Medical Center all perform worse than most other hospitals around the country in the survey’s overall patient-safety score.

NYSNA shared the criticisms and concerns raised by the Health and Hospitals Corporation (HHC) and other hospital representatives in decrying the survey that included many HHC facilities receiving low marks compared to the national average.

Both NYSNA and HHC questioned the “methodology and the outdated data employed” by the survey, which they said focuses on a very narrow range of criteria and does not consider numerous other relevant measures of quality patient care.

Survey criteria used

Consumer Reports used four criteria in the survey: hospital acquired infections, readmissions within 30 days, patient surveys regarding the adequacy of discharge instructions, and patient surveys regarding the adequacy of medication instructions.

“We recognize HHC has made significant strides in improving patient care and recognize (HHC president) Dr. (Alan) Aviles’ commitment to this task,” says NYSNA in a press statement.

“We note that the percentage of NewYork City’s patient population that is low-income, and suffering from long-term and complex health environments, is proportionately higher than in other areas. Such factors play a major role in assessing the quality of care provided by HHC, who generally care for a patient population sicker and more likely to be uninsured or underinsured.”

The report, however, raises broader issues that transcend the narrow confines of a survey in which relative comparisons inevitably set up a class of “underperformers,” who will necessarily fall into below-average rankings, regardless of the objective level of care provided, according to the NYSNA.

“The real question raised, but not addressed by, the report is this: Why do large hospitals in urban areas like New York City generally rate lower than other hospitals?” says the nursing group.

NYSNA said the quality of patient care is actually dependent on three interrelated factors: the health care needs of the patient population, the amount of funding available to provide the needed care, and the level of professional — particularly of registered nurse — staffing available to actually care for patients.

NYSNA said reimbursement and funding levels for hospitals, particularly in large urban areas, are under constant downward pressure.

“HHC has strained under the weight of a large uninsured patient population and continual budget cuts,” NYSNA said.

“The unsurprising result is constant pressure to reduce costs, which in the health services industry means to reduce staffing relative to patient populations. HHC RNs are asked increasingly to do more and more with less and less. With less funding, hospitals are forced to stretch their nursing and other patient care staff more and more thinly. The secret to high-quality patient care is not a mystery: if a hospital is properly funded and staffed, patients will get better care; if it is not, patient care will suffer.”

Who did well?

Only five hospitals in the New York area — and none in New York City itself — scored at or above the national average for all hospitals in the survey:

St. Francis Hospital in Roslyn, N.Y.; Peconic Bay Medical Center in Riverhead, N.Y., Saint Barnabas Medical Center in Livingston, N.J.; Glen Cove Hospital in Glen Cove, N.Y.; and Robert Wood Johnson University Hospital in New Brunswick, N.J.

The five lowest-rated hospitals nationwide are all in the New York area:

Jacobi Medical Center in the Bronx.; Nassau University Medical Center in East Meadow, Forest Hills Hospital in Queens, St. Joseph’s Medical Center in Yonkers; and St. John’s Riverside Hospital in Yonkers.

The hospitals offered various explanations for their poor performances, according to Consumer Reports.

For example, patients at Jacobi Medical Center speak more than 150 languages, a spokeswoman for the hospital said.

That might undermine its scores on communication about discharge and drugs, which are based on patient responses to a survey administered by the federal Centers for Medicare and Medicaid Services, it said.

In addition, the hospital sees mostly poor patients, many of whom suffer from substance abuse or mental illness and are uninsured, homeless or live in shelters, all of which compromise their ability to receive follow-up care and increase the risk for readmissions.

Similarly, a spokesman told the magazine that Forest Hills Hospital, part of the North Shore-Long Island Jewish Health System, “experienced significant improvement” despite the recent closure of several nearby hospitals, which put added pressure on it.

The author of the report, however, was scathing in his analysis, saying that while the city has some of the best doctors and facilities, “when it comes to patient safety, New Yorkers often receive substandard care.”

The author, Dr. John Santa, agrees that large, urban population can make it harder for hospitals to provide high-quality care.

“But they’re no excuse for being unsafe,” he said.

He points out that other hospitals in the country and the region that serve similar populations do better.

And some measures, like prevention of bloodstream infections in intensive care units linked to central-line catheters, reflect mostly staff performance, not patient characteristics.

“No patient, no matter how poor, should put up with substandard care,”he said.

‘N.Y. must take action’

Meanwhile, NYSNA has demanded that New York Gov. Cuomo and Mayor Michael Bloomberg take immediate action to provide healthcare funding that allows hospitals to provide quality care to patients.
All public services — from schools to hospitals — must receive the funding they need and deserve, it said.

“This will require a tax system that is fairer to middle and working-class families and makes the super-wealthy pay their fair share, so all New Yorkers can access to the best possible care,” the nursing organization said.

NYSNA, likewise, urged HHC to take responsibility for guaranteeing that nurses are able to provide high level care to patients.

“The heartfelt commitment to patient care expressed by Dr. Aviles must be applied at the corporate and hospital level in a tangible way,” it said.

Accordingly, it is the NYSNA’s demand and expectation that HHC adhere to the following:

• Each HHC hospital and facility must apply the resources necessary to provide proper nursing care on a sustained and consistent basis.

• HHC must strictly adhere to proper nurse to patient ratios in all units, so that RNs are able to focus on caring for their patients.

• HHC must provide sufficient ancillary staff to allow RNs to devote their attention to direct patient care.

• HHC must ensure that it can attract, recruit, train and retain quality nurses in numbers that are adequate to do the job.

• Nurses must be provided with a decent work environment free from punitive and abusive policies and practices.

• Nurses must be paid wages and benefits that are fair and comparable to those of other nurses doing the same or similar work, and their contract should be settled in a timely manner.

“Without a stable, dedicated and trained RN workforce and proper staffing in our hospitals, the quality of care cannot be improved and will not meet the needs and expectations of our patients,” says the NYSNA.

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