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Madigan leaders say they’ve corrected deficiencies cited in Pentagon review of its hospitals

Madigan Army Medical Center already had addressed several shortcomings in protecting patient safety at the time a high-profile Pentagon review of the military health system was released last week, according to senior hospital leaders and new performance data from outside experts.

The new numbers show that Madigan is on par with its civilian and military peers in limiting surgery-related infections. That’s a reversal of the three-year trend that was cited in the Pentagon report.

However, the hospital still is on the hook to write performance improvement plans this month to describe how it can further drive down rates of surgery-related infections while shoring up an obstetrics program that also came under scrutiny in the Pentagon study.

Madigan leaders say the data in the Pentagon study and the requirement to write new performance improvement plans will lead to better care for military families in the South Sound.

“It doesn’t feel very good right now, but we’re not fearful of it. We know where the challenges are. We have the willingness to look, the desire to learn and truly the desire to be better,” said Madigan Commander Col. Ramona Fiorey.

She and two other senior Army medical leaders met with The News Tribune on Tuesday to discuss the report and release updated statistics on patient safety. They’re holding a town hall for patients at 6 p.m. Wednesday at Joint Base Lewis-McChord’s French Theater.

Their outreach follows the publication of a 700-page Pentagon review that included detailed performance assessments of each military medical treatment facility and orders from Defense Secretary Chuck Hagel for each hospital to address its deficiencies.

Madigan in the report had comparably poor showings in birth trauma and in patient morbidity, meaning patients at the hospital south of Tacoma had more complications following surgeries than patients at other hospitals.

The patient morbidity data was based on reports by the American College of Surgeons National Surgical Quality Improvement Program from July 2010 to June 2013, while the obstetrics assessment came from National Perinatal Information Center.

A new report from the American College of Surgeons that covers all of 2013 shows that Madigan now has patient morbidity rates at about the same average as its peers. The data covers nine kinds of complications that commonly follow medical procedures, such as surgical site infection or pneumonia.

Madigan had been tracking patient morbidity trends for the past four years and working to reverse them through training and the standardization of a number of procedures involving antibiotics, surgical preparation and catheters.

“We were not surprised by what was in the (Pentagon) review because we had already identified that,” said Madigan Chief Medical Officer Col. Stephen Yoest. “Over a period of two to three years, we drove those surgical site infections down to the point where we are no longer an outlier.”

The ob/gyn issues cited in the review are more challenging to explain.

Madigan, which delivered 2,264 babies last year, has a comparably high rate of mothers with medical conditions that could complicate births, according to a comparison between the hospital and the average cited by the National Perinatal Information Center.

Madigan’s rate of post-partum hemorrhaging was cited as a weak spot in the Pentagon review, which compared the hosptial with a national average. Madigan’s rate, however, is similar to other hospitals that typically serve mothers with complicated medical conditions.

Madigan also turns to cesarean sections far less frequently than other hospitals, according to hospital data. Its emphasis on vaginal delivery could be a factor in the higher rates of birth-related trauma cited by the Defense Department report, Yoest said. Both methods produce healthy babies, he said.

Hagel requested the systemwide review of military hospitals in late May following complaints about severe delays in care for patients at the Department of Veterans Affairs. The VA is a separate agency from the 56 hospitals around the world that report to the Pentagon, though both can care for former military service members. Hagel’s call for a systemwide audit coincided with the publication of a series of New York Times stories that drew attention to comparably high error rates in the military health system.

The military review on the whole called the system an average one with varied performance among its hospitals. Hagel and military medical leaders want to create a more standardized system.

The doctors who spoke with The News Tribune wanted to counter a perception that the hospital was providing substandard care. They stressed that military hospitals are part of a small minority of medical facilities that participate in the performance surveys that were cited in the Pentagon report.

Maj. Gen. Thomas Tempel Jr., acting commander of the Army’s Western Regional Medical Command, said his wife gave birth to their daughter at Madigan 19 years ago. He was thinking about that time when he returned to JBLM for his current assignment.

“If I had to do it over again, I wouldn’t change a thing,” he said.

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