Key:

starThe best possible results

plusBetter than comparison group

checkSimilar to comparison group

minusLags behind comparison group

not applicableNot applicable

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Keeping Patients Safe

Over the past decade, patient safety has become a topic of national concern and during this period, the health care industry has learned about improving patient safety from scientific study and from studying other industries, such as the aviation industry.  Massachusetts General Hospital physicians, nurses, and scientists alike have been at the forefront of efforts to identify and address the various threats to safety in a hospital setting.  All staff and employees at MGH are now, more than ever, focused on making our patients’ hospital experiences free from harm.

Click on any of the measure names below to see a detailed description of the measure, our performance over time and what we are doing to improve. On the chart below, hover your mouse over the data columns or icons to see more information.

MeasureOur Current PerformanceComparison GroupHow We Compare
Healthcare Associated Infections
MRSA Incidence
0.30 new cases
Per 1000 patient days (Oct-Dec 2013 data).
0.33
Currently there is no national benchmark or target for new cases per 1000 patient days. We compare ourselves to our average from the previous year (2012).
MGH's current performance is better than the 2012 average, but not at our internal goal of no (zero) new cases.
VRE Incidence
0.43 new cases
Per 1000 patient days (Oct-Dec 2013 data).
0.49
Currently there is no national benchmark or target for new cases per 1000 patient days. We compare ourselves to our average from the previous year (2012).
MGH's current performance is better than the 2012 average, but not at our internal goal of no (zero) new cases.
Central-Line Associated Bloodstream Infections in the ICU
1.47 infections
Per 1000 line days using Jul-Dec 2013 data.
1.4
The 2011 pooled mean for Combined Medical/Surgical ICU units from the NHSN (National Healthcare Safety Network) for infections per 1000 line days in major teaching hospitals.
Our current performance is in line (+/- 0.10 pts) the NHSN benchmark.
Preventing Central Line Infections: Saving Lives and Dollars
Hand Hygiene
88% before
94% after
Dec 12-Dec 13 data. Higher values are better performance.
90% before
90% after
The Joint Commission (TJC) sets this compliance expectation for all hospitals.
MGH's current before performance is in line with (+/- 2.0 pts) and our after performance is better than the Joint Commission compliance expectation but we are not at our internal goal of 100% before and after contact.
Hand Hygiene: Cleaner Hands, Safer Patients
MeasureOur Current PerformanceComparison GroupHow We Compare
Nursing Sensitive
Patient Falls with Injury on Medical Units
0.61 falls with injury
Per 1000 patient days (Oct12-Sep13 data).
0.61
Oct12-Sep13 average rate of falls with injury per 1000 patient days for Massachusetts hospitals with 500+ beds determined by PatientCareLink.
Difference from Group Rate (hospitals with more than 500 beds) is not statistically different according to the PatientCareLink Statistical Appendix.
One Fall is Too Many: MGH working to reduce patient falls with injury
Patient Falls with Injury on Surgical Units
0.29 falls with injury
Per 1000 patient days (Oct12-Sep13 data).
0.34
Oct12-Sep13 average rate of falls with injury per 1000 patient days for Massachusetts hospitals with 500+ beds determined by PatientCareLink.
Difference from Group Rate (hospitals with more than 500 beds) is not statistically significant according to the PatientCareLink Statistical Appendix.
One Fall is Too Many: MGH working to reduce patient falls with injury
Pressure Ulcer Prevalence on Medical Units
2.13 pressure ulcers
per 100 patients
Data from 4 MGH Pressure Ulcer Prevalence Studies - Dec12, Mar 13, Jun 13, and Sep 13.
1.65
Average per 100 patients for Massachusetts hospitals with 500+ beds determined by PatientCareLink (Dec 12, Mar 13, Jun 13, and Sep 13).
Difference from Group Rate (hospitals with more than 500 beds) is not statistically significant according to the PatientCareLink Statistical Appendix.
Pressure Ulcer Prevalence on Surgical Units
1.78 pressure ulcers
per 100 patients
Data from 4 MGH Pressure Ulcer Prevalence Studies - Dec 12, Mar 13, Jun 13, and Sep 13.
1.28
Average per 100 patients for Massachusetts hospitals with 500+ beds determined by PatientCareLink (Dec 12, Mar 13, Jun 13, and Sep 13).
Difference from Group Rate (hospitals with more than 500 beds) is not statistically significant according to the PatientCareLink Statistical Appendix.
MeasureOur Current PerformanceComparison GroupHow We Compare
Serious Reportable Events
Surgical Events
9
MGH had 9 Surgical events in 2012.
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
Product or Device Events
3
MGH had 3 Product or Device events in 2012.
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
Patient Protection Events
0
MGH had no Patient Protection events in 2012.
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
Care Management Events
20
MGH had 20 Care Management events in 2012.
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
Environmental Events
0
MGH had 0 Environmental events in 2012.
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
Radiologic Events
0
MGH had 0 Radiologic Events in 2012
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
Criminal Events
0
MGH had no Criminal events in 2012.
n/a
All hospitals aim for zero events.
All hospitals aim for zero events.
MeasureOur Current PerformanceComparison GroupHow We Compare
Leapfrog Safety
Prevent Medication Errors (Use of CPOE)
Fully meets standard
Based on 2013 survey submission.
Fully meets standard
Highest rating given by the Leapfrog group.
MGH has achieved the best possible rating by the Leapfrog group.
Appropriate ICU Staffing
Fully meets standard
Based on 2013 survey submission.
Fully meets standard
Highest rating given by the Leapfrog group.
MGH has achieved the best possible rating by the Leapfrog group.
Steps to Avoid Harm (Safe Practice Score)
Fully meets standards
Based on 2013 survey submission.
Fully meets standards
Highest rating given by the Leapfrog group.
MGH has achieved the best possible rating by the Leapfrog Group.
Managing Serious Errors
Fully meets standard
Based on 2013 survey submission.
Fully meets standard
Highest rating given by the Leapfrog group.
MGH has achieved the best possible rating by the Leapfrog group.
Reduce Central-Line Infections in ICUs
Some progress
Based on 2013 survey submission.
Fully meets standard
Highest rating given by the Leapfrog group.
MGH has made some progress on this Leap.

 

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