Health Ministry recommends surgery dept. changes

Public and private hospitals’ surgical departments should improve their documentation of operations; do more to prevent in-hospital infections, especially by giving prophylactic antibiotics and using better disinfection techniques; closely watch all patients in serious conditions; and give them better explanations before patients sign consent forms.

These were among the recommendations of a report by the Health Ministry’s quality survey department on 31 surgical departments (among 40) of various sizes in public and private hospitals around the country, except for Jerusalem, at the end of 2011.

The report was originally released for publication on February 26, but the ministry extended the embargo to Sunday, March 3, and then again to Monday, March 4.

The ministry’s spokeswoman’s office released a new version of the 60-page, Hebrew-language report on Friday, without stating what corrections were made. Her office said the differences were minor and resulted from the hospitals covered in the report – but not mentioned by name – taking their time to read it and give feedback, resulting in the ministry making insignificant changes on how many hospitals were large, medium and small. The corrected report will be placed on the ministry’s website on Monday.

The ministry report did not give any names of hospitals with high or low marks; thus surgical patients cannot assess where they can receive better care.

Sent to heads of the ministry and the four health funds, the document also said that private hospitals should be required to write down the official codes of diagnoses, use alcohol gel instead of the less effective Polydine solution for disinfecting the skin before surgery and ensure that a senior physician is always accessible for serious cases after surgery.

Eleven surgical departments in smaller hospitals with up to 300 beds; 14 departments in hospitals with between 301 and 800 beds; and six departments in larger hospitals with more than 800 surgical beds were examined.

One department was studied without informing management in advance in each hospital. The departments were checked for receiving patients, preparing them for surgery, the operations themselves, post-operative care, medical documentation, giving blood, safety and rights of the patients, contact with the family, prevention of infection, and medical staffers on late and weekend duty.

The average score was 90 percent, with the largest hospitals ranking 94.5%, followed by the medium-sized hospitals at 90.3% and the smaller ones at 82.7%. The privately owned hospitals had the lowest scores, averaging 82.7%; these for-profit hospitals constitute over half of the the smaller hospitals, and the variation among them was the largest. Hospitals owned by the largest health fund, Clalit Health Services, had the best achievements, compared to the government-owned and private hospitals.

The factors for which hospitals received the lowest grades were preparation for surgery, explanations given to the patients before signing consent forms and their documentation. One hospital didn’t document the staffers’ going over the type of operation before it was to be performed, and at seven medical centers, the documentation was only partial. Private hospitals performed better on documentation before the operation than public ones. In addition, it was found that a fifth of reports on operations were unreadable and not computerized, and in private hospitals, documentation on surgical followup and treating pain was less satisfactory than in public ones.

Prof. Yoel Donchin, director of the Patient Safety Unit at Hadassah-Hebrew University Medical School in Jerusalem and a long-time anesthesiologist at Hadassah University Medical Center in Jerusalem’s Ein Kerem, commented that “transparency is not desired by hospitals. The fact that the Health Ministry cooperates with these assessment is due only to the fact that the names of the hospitals are kept hidden.”

But, Donchin continued, “if the ministry itself takes the data and reaches conclusions on what should have been done by the hospitals according to ministry instructions in any case – if it doesn’t realize that it is in charge of most of the hospitals and supervise what is going on there, the time has come to increase supervision of the weaker hospitals. The ministry,” he said, “must form teams to study the nurses and manpower in general, as well as budgets and crowding and improve results as well as giving the hospitals the means to do so.”

Instead, said the senior Hadassah anesthesiologist and quality-control expert, “as I constantly point out, following the ministry’s directives does not cost money but ensure that instructions are followed.

Without giving names and ratings of hospitals, or practical conclusions on how to improve,” the ministry report “is laughable, and not even a fig leaf.

“Perhaps,” Donchin concluded, “the hospitals are wearing an eye patch so as not to see what is really going on, why and especially how to prevent problems.”