Hospital Performance Measures: the waiting period for stroke treatment was shortened; Improved catheterization times


The 2016 Hospital Quality Indicator Index published by the Ministry of Health today shows an improvement in almost all of the measures examined. For the first time, the national index, which includes 28 general hospitals, 42 geriatric institutions, 20 psychiatric departments and hospitals, and ambulatory services, also includes an examination of local early devilment clinics - most of which do not meet the targets set. 

According to the index, the patient's waiting time for an MRI or CT scan from the time the patient entered the hospital in the event of a stroke was reduced from an average of 55 minutes in 2015 to an average of 38 minutes in the past year. A comparison between the hospitals shows that Ziv Medical Center in Safed leads with only 18 minutes waiting, Hadassah Hospital Ein Karem in Jerusalem followed with 21 minutes, and the Galilee Medical Center in Nahariya follows in third place with a 25 minute waiting period.At the bottom of the list is the Wolfson Hospital in Holon, with an average waiting time of 75 minutes before imaging for a patient with a suspected stroke. At Laniado Hospital in Netanya patients have to wait 60 minutes on average, and at Ichilov Hospital in Tel Aviv - 59 minutes. Every year there are approximately 13,000 stroke cases in Israel, and the maximum efficiency of treatment is up to three hours after the event. No target is set for the index, but the international standard is 25 minutes from entrance to the hospital.

In cardiology, "cardiac catheterization was measured within 90 minutes of arrival at the hospital" - a critical measure for patients with acute heart failure. For this measure, there was an increase every year. In 2013 only 68% of hospitals met the standard, and last year 90% of hospitals met the target. A comparison of hospitals reveals that Carmel Hospital in Haifa was at the top of the list with 95% of the cases, followed by Poriya Hospital in Tiberias, Kaplan in Rehovot and Assaf Harofeh in Tsrifin with 94% of the cases.
The Meir Medical Center in Kfar Saba, which was in first place last year and scored a 94%, dropped to the bottom of the list with 88%. It was replaced by Wolfson, Barzilai, Ashkelon and Soroka Hospital in Be'er Sheva - the largest and only regional hospital among the best - with 93% of the cases. Other large regional hospitals, such as Sheba Medical Center in Tel Hashomer, Shaare Zedek in Jerusalem and Ziv in Safed, met the target in about 85% of the cases.In general, women seem to receive treatment later than men. This is due to the blurring of signs indicating a cardiac emergency. There was also a significant difference in treatment within 90 minutes, mainly at the age of 80 and over - 73% of the women were treated within this time period, compared with 85% for men.

The study also examined the "recommendation for aspirin after a heart attack" as aspirin is known to reduce the risk of death, cerebral events, and cardiac events by about 20%. In this indicator, all hospitals showed high data of at least 94%. At the top of the list are Mayanei HaYeshua Hospital in Bnei Brak, Poriya in Tiberias and Meir in Kfar Saba with 100% of the cases. Beilinson in Petah Tikva, Shaare Zedek in Jerusalem, Kaplan in Rehovot, Assaf Harofeh in Zrifin, and Ziv in Safed after them, with 99% of the cases.

In the case of suspected acute heart failure - an immediate life-saving operation that entered the measurement index this year - yielded high data with 95% on average. In the field of emergency medicine, the index of "giving instructions by telephone to perform resuscitation on suspicion of cardiac arrest" - an important process that assists a passerby or a family member to save lives until rescue services arrived - averaged 90%, but 40% Refuse to perform CPR, despite solicitations.

A major indicator examined was "functional evaluation in the rehabilitation departments following a hip fracture" - a common injury to elderly people who are undergoing rehabilitation and the main cause of disability and a decline in quality of life. In this index, most of the hospitals met the target of 85% and only three rehabilitation hospitals did not meet the goals - Neot HaTin, 71%, Beit Levinstein with 64%, and Beit Belev in Bat Yam with 61%. 

In addition, preventive antibiotic treatment for women was measured for caesarean section - a common operation performed in Israel 28,000 times a year. Studies have shown that prophylactic antibiotics at the time of surgery significantly reduce mortality and morbidity due to postpartum infections, and the target for 2016 has risen to 90%. However, not all the hospitals in Israel reached the target.  At the bottom of the list is Mayanei HaYeshua Hospital with only 72%, Ziv in Safed with 82%, and Wolfson Hospital in Holon with 87%. This compares to the Nahariya Medical Center with 100% performance, and Kaplan in Rehovot, Ha'emek in Afula, and Soroka in Be'er Sheva, with 99% performance. 

Another significant improvement in the gynecological field is the prophylaxis during a hysterectomy - a common surgical procedure among older women, performed 4,500 times a year in Israel. At the beginning of 2014, antibiotic treatment was given only in 51% of the cases, whereas in 2016 the average performance level increased to 92%. Laniado Hospital is the only one with a low level of preventive care, with 47% of cases."Tipat Halav" clinics did not meet targets for postpartum depression. 

For the new indicators that were added this year, Tipat Chalav clinics in Israel were examined. One of the most important services at the clinic is locating women with postpartum depression, which the nurses perform by filling out a postpartum birth and follow-up questionnaire. The target for clinics is 80% of diagnosis and follow-up cases, but many clinics do not meet the standard. 

The Tipat Chalav clinics of the Tel Aviv-Jaffa Municipality worked to locate women suffering from depression only in 31% of cases, followed by lower-quality clinics in the Southern District of Clalit Health Services, 53%, and 63% in Jerusalem. The Ministry of Health in the Northern District has 94% of the clinics in the Ministry of Health, 90% in Ashkelon and 90% in the Sharon region.

We will also examine dispensing of vaccinations and completion of three head size measurements for infants up to the age of eight months for the first time in the Tipay Chalav clinics. In the last index whose goal was set for 95% performance, Meuhedet Health Services had a low performance of 76%, followed by Leumit with 83%. This compares to 95% performance of Maccabi Health Services and of the Tel Aviv-Jaffa Municipality.

The immunization index up to the age of 13 months, which recently made headlines with the Ministry of Health's call for additional MMR vaccinations for infants who go abroad due to an increase in the incidence of measles, shows that the routine vaccination routine includes this vaccine, but the vaccination rate at the recommended time is 60%. According to the index, mainly because of low cooperation on behalf of the parents, the lowest rate of immunization is only 46%. 

High satisfaction with mental health care centers 

This is the second year that the Ministry of Health has conducted a patient satisfaction survey at mental health centers. The survey was conducted this year among 1,032 adult patients in the 11 mental health centers in Israel. The three hospitals and psychiatric departments that received the highest satisfaction rate were Beersheba psychiatric hospital with 79%, Hod Hasharon with 78%, and Geha with 76%. 

At the bottom of the list are the Jerusalem Center and the Psychiatric Department at Tel Hashomer Sheba Hospital, both with 65% satisfaction. In general, women were more satisfied than men - 82% vs. 70%, respectively - and younger patients were less satisfied than adults - 68% satisfaction among those aged 18-34, 77% among those aged 35-64, and 87% .

90% of the patients felt safe and secure during the hospitalization, 92% reported a respectful attitude from the staff, 93% said their privacy was maintained, and 81% reported that they felt that they were in good hands during hospitalization.  Satisfaction with hospital room comfort was 82%, availability of clean clothing and bedding was estimated at 93%, and 86% said that it was quiet at night.

However, most of the patients' criticism pertained to services during the afternoon and the weekends. 60% reported that there were no activities for them at this time, such as sports activities. Difficulties also arose after completion of treatment, and more than half of the patients indicated that hospital staff had not prepared them fully for release. Moreover, about 40% of the patients indicated that they did not fully understand their treatment plan.