Cottage Gets a Check Up

Though most levels of care at the three Cottage hospitals in Santa Barbara County fall in line with those of medical centers throughout the United States, a federal government report reviewing 4,500 U.S. hospitals found that Santa Barbara Cottage Hospital lags in treating surgery patients with preventive antibiotics one hour before incision as well as stopping the antibiotics within a day of the completion of surgery.

Compared to the average for all reporting hospitals in the U.S., Cottage is 25 percent below the national average in administering preventive antibiotics before surgery incision, offering the medicine only 52 percent of the time. The timing is important because patients who receive antibiotics within an hour prior to their operation are less likely to get infections. When it comes to making sure surgery patients stop taking their preventive antibiotics within 24 hours after surgery, Cottage is 43 percent below the national average at only 29 percent. Taking the antibiotics for more than 24 hours after surgery is usually not necessary, and the risk of side effects, including a resistance to antibiotics in the future, can increase.

Initiated by the U.S. Department of Health and Human Services, the report analyzes the quality of care patients are receiving from their hospitals. On its Web site, the Centers for Medicare & Medicaid Services in Washington, D.C., an agency within the DHHS, provides a total of 22 criteria measures in four different areas-heart attacks, heart failures, pneumonia, and surgical care improvement/surgical infection prevention-from admission to discharge. The report does more than provide information for the public, according to CMS acting administrator Leslie V. Norwalk; it also provides hospitals with information to analyze and hopefully improve their performance levels. “These reports serve as a tool to help hospitals look more broadly at their outcomes and processes of care and identify ways to lower mortality risk for their patients,” she said.

Dr. Sharon Lutz (pictured above), the vice president for quality support services at Cottage, said that while the numbers contained in the report are accurate, Cottage-the largest private employer in the county-has taken steps to make improvements. One reason for the low numbers is the way Cottage was organizing its data. “We’re often doing the right thing, but we’re not documenting in the right way,” Lutz said. “It’s a matter of putting a system in place to help track this.” The system is moving from paper to electronic documentation-a multimillion-dollar transition-so that more solid information can be collected and organized. The low numbers could also result from CMS using out-of-date criteria and hospitals themselves using newer and better methods or medications. Changing the entire system takes time, Lutz said. “They set forth the definition of best practices : but the doctors might see new literature, and CMS might lag behind.”

But that’s not to say there aren’t positive numbers reported for Cottage. The hospital was in line with the majority of U.S. hospitals when it came to cardiac patient mortality rates up to 30 days after their visits to the hospital. And Cottage scored higher than the national average in passing out aspirin and medicine to patients during their arrival and discharge. The medicines are used to lower blood pressure and treat chest pain and heart failure as well as to prevent heart attacks. Cottage, at 96 percent, also came in six points above the national average and seven above the regional average in terms of the percentage of surgery patients who received the appropriate antibiotic for their procedure. Different types of antibiotics help prevent wound infection for different types of surgery.

Numbers for the most recent months haven’t yet been released, but officials at Cottage Health System, which treated 62,000 people in its three 24-hour emergency departments last year, are planning to post all of its data on the Cottage Health System Web site sometime later this summer to show how Cottage stacks up nationwide on the different measures. “Cottage is very committed to public reporting,” said Lutz, who noted that even good numbers can improve and that success with 100 percent of its patients is a goal for Cottage. The data release by CMS is a constant reminder of where the hospital is, and where it wants to go. “I can say across the board we are seeing improvements,” she said. “We’re on a path to get ahead of public responsibility and be accountable to our community.”