I think the hospitals in Georgia, and more specifically in Savannah, are fantastic and I don’t want any negative talk about my hospitals either. A recent national study rated hospitals in Georgia thirty-seventh in the nation. North Dakota was first. (The hospital judges must also work part-time at dog shows.) The Leapfrog Group recently reviewed the hospitals in Savannah and our hospitals generally came up short of expectations. This Group is composed of leaders of national large businesses representing some fifty million employees. They use their economic clout to steer the course of healthcare in the country. Their purpose is to address and offer solutions to the problems in the U.S. healthcare system. They use an incentive system - demonstrate high quality and our employees will be steered toward your hospital. Taking the data from the study of the Institute of Medicine reporting the high frequency of medical errors that lead to poor outcomes (i.e. longer hospital stays, surgical complications) and thousands of deaths annually, the Group studied the New York State healthcare system. Because this state has a computerized data collection system, the Group was able to collect health information such as the mortality and length of stay for patients having coronary by-pass surgery or aortic aneurysm surgery at most New York state hospitals and by individual surgeons. The results indicated that hospitals and surgeons with the greatest volumes of surgeries had better results than those with lower volumes. For by-pass surgery, the magic number in the populous state of New York is approximately 450 per year. Not that many are done at St. Joseph’s, Candler or Memorial Health University Hospital. Most hospitals in the country do not do that many procedures. In another area of study, the Group recommends that hospitals move to computerized systems for physician orders and medication distributions in order to reduce common errors. Both Savannah hospital systems are making progress in this arena and deserve praise for having the courage to spend the massive amounts of money needed to introduce computerized ordering systems at a time when funds are limited and when some hospitals have already reported disastrous consequences for their physicians and their hospitals. Regarding a third area of interest, the Leapfrog Group wants specialists in the hospital or very nearby to serve the needs of patients in intensive care units. This is nearly completely accomplished at Memorial Health. In a city of our size, the lead physicians can be on site at any of the hospitals within minutes. This is not New York City.

Hospital grading is a very imperfect science to say the least. I offer only one example. There is a very important factor that has not been controlled in any of the hospital quality studies to date. It has to do with “the transfer factor.” Patients that come to a referral hospital from another hospital are more likely to be sicker, more likely to be admitted to an ICU and are more likely not to survive. The Savannah hospitals serve as referral centers for all the smaller, rural hospitals. From trauma to heart attacks, very ill patients come to your hospitals from these smaller, less well equipped rural hospitals. In a recent study from the University of Michigan, patients transferred to an intensive care unit from another hospital have a forty percent longer hospital stay and are twice as likely to die in the hospital. From a grading point of view, our hospitals will have lower quality healthcare assessments than referral hospitals that do not accept ICU transfers. The impact of a perceived lower quality of care is no longer simply an issue of vague adverse rumors for a hospital because The Leapfrog Group and other such grading groups expect insurers, representatives for large patient groups, and the government to use such data to make important healthcare decisions that steer patients in certain directions. The ultimate objective of the Leapfrog Group is to provide the highest quality for the best price. The problem is that the computer-generated data is top –heavy regarding volume, cost, and outcomes and I have not seen more than crude interpretations of that data. The hospital grading groups must incorporate the day-to-day issues of hospital dynamics into their assessments and offer financial solutions for the massive costs of re-tooling our hospital information systems. That is not to say that Savannah hospitals are perfect. I work in all three major hospitals every day and offer that they are respectable but need work. Of course, they can and must improve if they are to keep the currently well-deserved confidence of the community. The Savannah hospitals are a lot like my pup, Sergei. I know he is not perfect, but he is quite good. If you choose to criticize my dog, be sure you know the difference between a Borzoi and a Bassett.

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