With recurring infection should Congressman Scalise have been transferred to another hospital rather than to the ICU where he is hospitalized?

About twenty years ago as President of LibertyHealth each of our hospitals (a medical school affiliated teaching hospital and two community hospitals) had an ICU. I was always concerned that sometimes patient acuity in one of the community hospital ICUs might have exceeded its capability and pushed for clear clinical threshholds for patient transfer to the teaching hospital ICU.
Which brings me to Congressman Scalise…
“A lone gunman who was said to be distraught over President Trump’s election opened fire on members of the Republican congressional baseball team at a practice field in this Washington suburb on Wednesday, using a rifle to shower the field with bullets that struck four people, including Steve Scalise, the majority whip of the House of Representatives.”
“His injuries are extensive, and he was in critical condition Wednesday night, MedStar Washington Hospital Center said in a statement. As the bullet traveled across his body, it broke bones, tore up internal organs and caused major internal bleeding.
Doctors operated immediately, but additional surgery is required, the hospital said.” (A)

Mr. Scalise underwent several surgeries last month, and his condition improved from critical to fair. However, hospital officials on Wednesday said he was moved back to the ICU. Mr. Scalise had another surgery Thursday to manage infection and is now in serious condition, according to the report.
Soon after his rehospitalization, attention shifted toward Washington Hospital Center’s publicly available grades for patient safety and care quality. The Leapfrog Group gave Washington Hospital Center a D in hospital safety ratings for 2016, and CMS’ Hospital Compare website shows the hospital earned 2 out of 5 stars in the most recent update.
“[I]nfections [at the hospital] are a pattern and a serious one,” Leapfrog Group CEO Leah Binder told USA Today. “They are significantly below the national average in four out of five areas that we have data, which suggests an inability to prevent infections.” (B)

a little old (2014)
“Staff at the region’s largest private hospital — MedStar Washington Hospital Center — have given it consistently low marks in key areas of patient safety over the past four years, according to results released Friday.
Although doctors’, nurses’ and administrators’ perception of patient safety has improved during that time — in some cases significantly — the hospital scores below the national average in seven out of 12 patient safety measures in key areas, including the overall perception of safety at the hospital and the ability of staff to report mistakes without fear of punishment.”

June, 2017
“Like many other hospitals across the country, MedStar Washington Hospital Center has been experiencing the financial impact of numerous changes in health care,” the statement from MedStar said. That has included the nationwide nursing shortage that forced the health system to use agency nurses to fill critical positions, as well as “inflationary pressures” that have driven up costs of pharmaceuticals and medical supplies.
MedStar officials also pointed to investments in the last year that have required additional staff, such as the creation of a Sepsis Response Team and the Behavioral Emergency Response Team, that have impacted the budget. The health system saw positive effects from those investments, such as reductions in hospital-acquired infections, and it intends to leave those teams intact, officials said. (C)


So I would be digging deeper…..but understand this can be quite frustrating
The U.S. News analysis of hospitals includes data from nearly 5,000 centers across multiple clinical specialties, procedures and conditions. Scores are based on a variety of patient outcome and care-related factors, such as patient safety and nurse staffing. Hospitals are ranked nationally in specialties and regionally in states and major metro areas. U.S. News assigns a rating to hospitals in a handful of common procedures and conditions, including hip replacement and COPD. This hospital achieved the highest rating possible in 5 procedures or conditions.
To see the U.S. News rankings of MWHC highlight and click on http://health.usnews.com/best-hospitals/area/dc/medstar-washington-hospital-center-6330120

The information on Hospital Compare:
Helps you make decisions about where you get your health care
Encourages hospitals to improve the quality of care they provide
In an emergency, you should go to the nearest hospital. When you can plan ahead, discuss the information you find here with your health care provider to decide which hospital will best meet your health care needs.
To see Hospital Compare’s ratings of MWHC highlight and click on https://www.medicare.gov/hospitalcompare/profile.html#profTab=0&ID=090011&loc=WASHINGTON%2C%20DC&lat=38.8951118&lng=-77.0363658&name=MEDSTAR%20WASHINGTON%20HOSPITAL%20CENTER&Distn=3.3

Completed by more than 1,800 hospitals annually, the flagship Leapfrog Hospital Survey collects safety, quality, and resource use information you can’t find anywhere else. We report on the issues that matter to patients and purchasers—from maternity care and surgical outcomes, to handwashing policies and nursing standards.
To see Leapfrog’s report on MWHC highlight and click on

An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
To see JCAHO’s most recent accreditation report for MWMC highlight and click on

whew! That’s hard work

Maybe we need to designate levels of ICUs just as we do for trauma centers and perinatal centers.
Here’s one example:

LEVEL 1: should be capable of providing immediate resuscitation and short-term cardiorespiratory support for critically ill patients; will also have a major role in monitoring and prevention of complications in “at risk” medical and surgical patients; must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring for a period of at least several hours
LEVEL II: should be capable of providing a high standard of general intensive care, including complex multi-system life support, which supports the hospital’s delineated responsibilities; minimum of 6 beds
LEVEL III: a tertiary referral unit for intensive care patients should be capable of providing comprehensive critical care including complex multi-system life support for an indefinite period; should have a demonstrated commitment to academic education and research; All patients admitted to the unit must be referred for management to the attending intensive care specialist; all consultants are FCICMs; may have over 50 beds, should include pods of 8-15 beds
PICU: as for a Level III unit, but dedicated to the care of pateints under the age of 16 years

(A) Steve Scalise Among 4 Shot at Baseball Field; Suspect Is Dead, by Michael D. Shear et al, https://www.nytimes.com/2017/06/14/us/steve-scalise-congress-shot-alexandria-virginia.html
(B) Medstar hospital’s poor safety ratings get limelight as it treats Rep. Steve Scalise, by Mackenzie Bean, http://www.beckershospitalreview.com/quality/medstar-hospital-s-poor-safety-ratings-get-limelight-as-it-treats-rep-steve-scalise.html
(C) MedStar Washington Hospital Center gets low marks from staff on key safety issues, by Lena H. Sun, https://www.washingtonpost.com/local/medstar-washington-hospital-center-gets-low-marks-from-staff-on-key-safety-issues/2014/07/18/94f3643e-0e95-11e4-b8e5-d0de80767fc2_story.html?utm_term=.d762fccecd67
(D) ICU Design and Staffing, https://lifeinthefastlane.com/ccc/icu-design-and-staffing/


Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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