CMS-10360 HAI_HAC_MockUps

CENTERS FOR MEDICARE & MEDICAID SERVICES

HAC and HAI Displays for
Hospital Compare
Draft
David Miranda
1/27/2011

Draft mockups and narrative for consumer testing of HAC and HAI measures

Hospital Compare

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Data available

 Data not available
General Information
HOSPITAL NAME,
ADDRESS
EDGEFIELD HOSPITAL
41 HIGHLAND AVE
WINCHESTER, MA 01890
(781) 555-9000
RIVER VIEW HOSPITAL
150 S. HUNTINGTON AVE
JAMAICA PLAIN , MA 02130
(617) 555-9500
MITCHELL HOSPITAL
800 WASHINGTON ST
BOSTON, MA 02111
(617) 555-5000

Safety
Measures

Quality of Care

Effectiveness
Measures

Patient-Centered
Measures

Timeliness
Measures

Measures of
Resource Use

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Hospital Compare
Medicare.gov>Hospital Compare Home>Hospital Results>Hospital Compare
Safety
Measures
Serious
Complications
Deaths from
Selected Medical
Conditions
Hospital-Acquired
Conditions
HealthcareAssociated
Infections

Effectiveness
Measures

Patient-Centered
Measures

Timeliness
Measures

Measures of
Resource Use

Hospital-Acquired Conditions (HACs)
Patients who enter the hospital for treatment of one medical problem sometimes leave with
additional injuries, infections, or other serious conditions that occur during their hospital stay.
Although some of these complications may not be avoidable, some could have been prevented if
the hospital had taken proper precautions. Hospitals are required to report how often patients get
any one of ten potentially avoidable conditions while being treated in the hospital.
The information below shows the number of cases reported by the hospitals you selected for each
hospital-acquired condition (HAC). Since these kinds of events are usually very rare, the numbers
shown are very small. This information can help you determine how well hospitals are preventing
or avoiding HACs and questions you may want to ask.
Read more information about Hospital-Acquired Conditions. Learn why Hospital-Acquired
Conditions are Important.

Hospital Compare
Information about Hospital-Acquired Conditions (HACs)
Patients who enter the hospital for treatment of one medical problem sometimes get other
serious injuries or conditions during the course of their hospital stay. The Deficit Reduction Act
(DRA) of 2005 requires the Secretary of Health and Human Services to identify common,
serious, high-cost conditions that could reasonably have been prevented if proper procedures
had been followed. Medicare will only pay hospitals for the treatment of these conditions if
patients already had the condition when they were admitted to the hospital. These payment
policies are designed to encourage hospitals to examine patients thoroughly when they are
admitted to the hospital to identify potential problems, take steps to reduce patients’ risk of
acquiring serious conditions while they are in the hospital, and avoid preventable medical errors.
Currently, Medicare will not pay for the ten types of avoidable hospital-acquired conditions
(HACs) listed below. People with Medicare are also not responsible for these costs.
1.
2.
3.
4.
5.

Foreign Object Retained After Surgery
Air Embolism (air bubble in the bloodstream)
Blood Incompatibility (mismatched blood types)
State III and IV Pressure Ulcers (serious pressure sores or bedsores)
Falls and Trauma (falls and injuries), including
o Fractures
o Dislocations
o Intracranial Injuries (head injuries)
o Crushing Injuries
o Burns
o Electric Shock
6. Manifestations of Poor Glycemic Control (signs of uncontrolled blood sugar), including
o Diabetic Ketoacidosis (buildup of ketones in the body)
o Nonketotic Hyperosmolar Coma (loss of consciousness due to extremely high
blood sugar and dehydration)
o Hypoglycemic Coma (loss of consciousness due to very low blood sugar)
o Secondary Diabetes (diabetes that develops due to another illness) with
Ketoacidosis
o Secondary Diabetes with Hyperosmolarity (concentration of salt, sugar, and
other substances in the bloodstream)
7. Catheter-Associated Urinary Tract Infection (UTI)
8. Vascular Catheter-Associated Infection
9. Surgical Site Infection following:
o Coronary Artery Bypass Graft (CABG) - Mediastinitis
o Bariatric Surgery
o Orthopedic Procedures
10. Blood Clots in a Large Vein (Deep Vein Thrombosis) or the Lung (Pulmonary
Embolism) following
o Total Knee Replacement
o Hip Replacement

Hospital Compare
What HACs Are and Why They Are Important
Name
Foreign object
retained after surgery
(Objects accidentally
left in the body after
surgery)

Description
This measure refers to objects, such as surgical instruments, sponges, or other foreign
objects, accidentally left inside a patient after a surgical procedure. Although these
kinds of occurrences are rare, they present considerable risk to patients and may
require additional surgery to remove the object.
The risk of having foreign objects left in the body in after surgery is higher during
emergencies. The risk is also higher when surgical patients are very heavy.
Hospitals can prevent this error by making sure members of the surgical team
communicate with each other and by counting sponges and other surgical instruments
throughout the surgical procedure.

Air embolism (Air
bubble in the
bloodstream)

This measure refers to air embolisms, which are blockages in the bloodstream caused
by an air or gas bubble. The symptoms of an air embolism can be similar to the
symptoms of a stroke or heart attack.
Air bubbles can get into the bloodstream during surgery or other medical procedures.
They often occur when tubes (central venous catheters) are inserted into or removed
from large veins.
Hospitals can prevent this serious complication by making sure that staff are trained in
proper procedures for inserting and removing central venous catheters and other tubes,
for removing air from syringes before giving injections, and for closely monitoring
patients during surgery.

Hospital Compare
Blood Incompatibility
(Mismatched blood
types)

This measure refers to the reaction that can occur when patients are given the wrong
type of blood. If a patient receives blood that is not compatible with their own blood
type, they can suffer a serious reaction. Symptoms may include back pain, blood in the
urine, fever, and yellowing of the skin.
Hospitals can avoid giving patients the wrong blood type by following guidelines to
make sure blood is properly typed and cross-matched, labeled correctly, and given to
the correct patient.

Pressure ulcers,
Stages III and IV
(Severe pressure
sores)

This measure refers to serious pressure sores (also known as bedsores) that develop
while a patient is in the hospital. Stage III and IV pressure sores are very deep,
serious sores that may even reach muscle or bone. They cause pain and serious
infections, and may lead to long hospital stays and even amputation.
Pressure sores are caused by staying in one position for a long period of time.
Hospitals can prevent them (or keep them from getting worse) by turning or moving
bedridden patients often and by regularly checking and caring for the patient’s skin.

Falls and Trauma
(Falls and injuries)

This measure refers to falls and injuries that occur while a patient is in the hospital,
including broken or dislocated bones, crushing injuries, burns, or shocks. Although
some falls and injuries may occur even when hospitals provide good care, many falls in
hospitals can be avoided.
Hospital staff should determine if patients are at risk for falls by checking patients’
balance and coordination, or reviewing the patient’s medications. Hospital staff should
also assist patients who are unable to move around safely on their own.
Hospitals can also reduce the likelihood of falls by removing clutter from floor, removing
improperly fitting clothing, keeping bed rails up when patients are sleeping, providing
enough staff and equipment when transferring a patient into and out of bed, and
installing handrails in areas where patients need stability.

Hospital Compare
Vascular catheterassociated infections

This measure refers to infections caused by a vascular catheter, which is a thin flexible
plastic tube inserted into a patient’s vein. Vascular catheters make drawing blood or
giving medications easy. Patients who need vascular catheters for a long period of time
may need to have them put in during surgery.
Vascular catheters can put patients at risk for infections and serious complications,
especially if they are kept in for long periods of time. These might include skin
infections at the site where the catheter was inserted and bloodstream infections.
Hospitals can prevent vascular catheter-associated infections by choosing the best sites
for inserting the catheter, using the right catheter material, keeping the site clean, and
removing the catheter when it is no longer needed.

Catheter-associated
urinary tract infection

This measure refers to urinary tract infections caused by a urinary catheter, which is a
flexible tube inserted into the bladder to collect urine. Patients who don’t have bladder
control may have urinary catheters left in place for long periods of time. As a result,
urinary tract infections are the most common kind of infection that hospital patients
get. Elderly patients or patients who have been very sick for a long time are at high
risk for these infections.
Hospital staff can help prevent urinary tract infections by keeping patients clean,
emptying drainage bags regularly, making sure patients get enough fluids, giving
antibiotics to patients who need catheters for long periods of time, and by removing
urinary catheters when they are not needed.

Manifestations of poor
glycemic control
(Signs of uncontrolled
blood sugar)

This measure refers to signs of poor blood sugar control in patients with diabetes,
which can lead to serious complications, coma, and even death. Although high blood
sugar (hyperglycemia) and low blood sugar (hypoglycemia) are common in hospitalized
patients with diabetes, extreme signs of poor blood sugar control are rare, and are
reasonably preventable if patients are monitored regularly.

Hospital Compare
Serious
Complications

Hospital-Acquired Conditions (HACs)
Lower Rates Are Better

Deaths from
Selected Medical
Conditions
Hospital-Acquired
Conditions
AVERAGE FOR ALL
REPORTING
HOSPITALS IN
THE U.S.

HealthcareAssociated
Infections
Foreign object retained
after surgery

EDGEFIELD
HOSPITAL

RIVER VIEW
HOSPITAL

MITCHELL
HOSPITAL

0.084

0

0

0

per 1,000
surgical discharges

per 1,000
surgical discharges

per 1,000
surgical discharges

per 1,000
surgical discharges

Air embolism

0.003

0.100

0.100

0

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

Blood incompatibility

0.001

0

0.01

0

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

Pressure ulcers, stages
III and IV
Falls and trauma
Vascular catheterassociated infection
Catheter-associated
urinary tract infection
Manifestations of poor
glycemic control

0.166

0.300

0.100

0

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

0.759

0.500

0.400

0.200

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

0.290

0.200

0.200

0

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

0.260

0.200

0

0.300

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

0.051

0

0.200

0.050

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

per 1,000
total discharges

Hospital Compare
Medicare.gov>Hospital Compare Home>Hospital Results>Hospital Compare
Safety
Measures

Serious
Complications
Deaths from
Selected Medical
Conditions
Hospital-Acquired
Conditions
HealthcareAssociated
Infections

Effectiveness
Measures

Patient-Centered
Measures

Timeliness
Measures

Measures of
Resource Use

Healthcare-Associated Infections (HAIs)
Healthcare-Associated Infections (HAIs) are infections that patients get as a result of medical
care. These may occur in any healthcare setting, including hospitals, surgical centers, clinics,
nursing homes, or rehabilitation facilities. Infections can result from many different kinds of
medical care, including medical devices (such as catheters and ventilators), surgical procedures,
or the prolonged use of antibiotics. These infections are also easily passed from one person to
another when healthcare workers do not wash their hands properly.
Healthcare-associated infections are the most common complication of hospital care and one of
the top 10 causes of death in the U.S. Many of these infections can be avoided if proper
guidelines are followed.
Read more information about Healthcare-Associated Infections. Learn why HealthcareAssociated Infections are Important.

Hospital Compare
Information about Healthcare-Associated Infections (HAIs)
Modern healthcare uses many types of devices and procedures to treat patients and to help them recover.
Infections can be associated with the devices used in medical procedures, such as catheters or ventilators.
These healthcare-associated infections (HAIs) include central line-associated bloodstream infections,
catheter-associated urinary tract infections, and ventilator-associated pneumonia, which account for
roughly two-thirds of all HAIs. Infections may also occur at parts of the body where surgery was
performed (known as surgical site infections). Additionally, clostridium difficile, a bacterial infection of the
gastrointestinal tract that may develop because of prolonged use of antibiotics during treatment, can
cause diarrhea and more serious intestinal conditions such as colitis.
HAIs occur in all settings of care, including hospitals, surgical centers, healthcare clinics, and in long-term
care facilities, such as nursing homes and rehabilitation facilities. They are one of the top 10 causes of
death in the U.S. and the most common complication of hospital care. Many of these infections can be
prevented through the use of proper procedures and precautions.

Hospital Compare
What HAIs Are and Why They Are Important
Name

Description

Central line-associated A central line-associated bloodstream infection is a serious infection that occurs when
bloodstream infection germs enter the bloodstream through a central line. A central line is a tube that’s
(CLABSI)
placed in a large vein in the neck, chest, or arm to give fluids, blood, or medications, or
to do certain medical tests quickly. It may be left in place for several weeks. Patients
(Bloodstream
who develop a catheter-associated bloodstream infection may become ill with fevers
infections caused by a and chills, or the skin around the catheter may become sore and red.
central catheter)
Hospital staff can prevent catheter-associated bloodstream infections by:
Choosing a vein where the catheter can be safely inserted and where the risk
for infection is small
Keeping the catheter sterile when putting it in place by cleaning their hands
beforehand; wearing a mask, cap, sterile gown, and sterile gloves; covering
the patient with a sterile sheet; and cleaning the patient’s skin
Keeping the opening clean, washing their hands, and using sterile gloves
when using the catheter to draw blood or give medications or when changing
the bandage
Removing the catheter as soon as it’s no longer needed

Hospital Compare
Hospital Safety Measures Tables
Healthcare-Associated Infection Measures
Lower Rates Are Better

Serious
Complications

Healthcare-Associated Infections
Lower Rates Are Better

Deaths from
Selected Medical
Conditions
Hospital-Acquired
Conditions
AVERAGE FOR ALL
REPORTING
HOSPITALS IN
THE U.S.

HealthcareAssociated
Infections
Central Line-Associated
Bloodstream Infection

EDGEFIELD
HOSPITAL

RIVER VIEW
HOSPITAL

MITCHELL
HOSPITAL

0.70 infections

0.70 infections

1.59 infections

0.45 infections

for every 1,000 days
central line catheter
in place

for every 1,000 days
central line catheter in
place

for every 1,000 days
central line catheter in
place

for every 1,000 days
central line catheter
in place

Hospital Compare
Hospital Safety Measures Graphs
Healthcare-Associated Infection Measures

Why is this Important?
Hospitals can prevent catheter-associated bloodstream infections by choosing a vein where the catheter can be
safely inserted and where the risk for infection is small. Hospitals can also ensure that hospital staff follow
appropriate hand washing and other infection control practices to reduce the risk of infection for patients.