Michigan Health & Safety Coalition Consumer Report

The coalition’s recommended guidelines

The Michigan Health and Safety Coalition reviewed how closely hospitals match our guidelines for improving patient safety. For the seven serious medical conditions, we looked at whether the hospital:

• Has measures that assist the physician in identifying when the procedure is medically necessary and assist staff in regularly reviewing patient records
• Monitors the health outcomes of patients who undergo the procedure and considers differences in patients before surgery
• Collects and records in a statewide database the clinical data for patients who undergo the procedure to help understand how to provide the best medical care

For some of the medical conditions, we had additional guidelines.

For low birthweight infants, we also looked at whether the hospital:

• Works with a board-certified or board-eligible neonatologist who directs the neonatal intensive care unit
• Has 24-hour in-house coverage by either a physician qualified in the intensive care of newborns or by a specially trained physician extender
• Has physician backup to the physician extender within 30 minutes

For removal of part of the esophagus due to cancer, we also looked at whether the hospital:

• Works with surgeons who have appropriate training and qualifications
• Uses a multidisciplinary tumor board which meets regularly to review and structure care
• Can provide care after surgery, including chemotherapy and radiation therapy

For infants with congenital anomalies, we also looked at whether the hospital:

• Works with a board-certified or board-eligible neonatologist who directs the neonatal intensive care unit

• Has 24-hour in-house coverage provided by either a physician qualified in the intensive care of newborn infants or by a specially trained physician extender

• Has physician backup to the physician extender within 30 minutes

• Possesses diagnostic tools such as radiology, ultrasound, MRI imaging and skilled interpretation of tests for the specific anomaly

• Has appropriate medical, surgical, and pediatric subspecialists available through established consultation and referral networks to coordinate consultations, referrals, and transfers between NICUs if needed

For the intensive care unit physician staffing guideline, the coalition looked at whether the hospital operates a "closed" intensive care unit for one or more of its adult ICUs and the ICU:

• Is managed by an intensivist (a board certified or board-eligible physician in critical care medicine) who directs clinical care for the ICU, monitors the admission and discharge criteria, and implements care protocols.
• Has the intensivist and the primary surgical or medical physician attending delivers care to patients.
• Has the intensivist available to the ICU from 8 a.m. to 5 p.m. and during other hours has the intensivist available to the ICU by phone or pager within 5 minutes
• Arranges for an specially qualified physician or physician extender to be present in the ICU within 5 minutes.