Quality Scores
CMS Quality Measures
Heart Attack-Congestive Heart Failure-Pneumonia-Surgical Infection Prevention
Other Relevant Quality Measures
Vent-Acquired Pneumonia-Trauma Care- Blood Stream Infection Rate
Hospital Compare - U.S. Dept. of Health and Human Services/Medicare.gov
HCAHPS Survey of Patients' Hospital Experiences
Minnesota Hospital Quality Report
Joint Commission Quality Check
Centers for Medicare & Medicaid Services (CMS)
Quality of Care Measures
Quality Measure:
Heart Attack |
St. Cloud Hospital Score
3rd Quarter 2011 to 2nd Quarter 2012 |
Minnesota
Average
|
| Aspirin at Discharge: Patients who are prescribed aspirin at discharge. |
100% |
99% |
| Statin (cholesterol medication) at Discharge: Patients who are prescribed a statin at discharge. |
99% |
98% |
| Angioplasty at Arrival: Patients who receive angioplasty within 90 minutes of arrival. |
89% |
93% |
Quality Measure:
Mortality Rate: Heart Attack |
St. Cloud Hospital Score
3rd Quarter 2008 to 2nd Quarter 2011 |
National Rate
|
Heart Attack 30-Day Mortality Rate
(A lower number is better.) |
15.7% |
15.5% |
Quality Measure:
Readmission Rate: Heart Attack |
St. Cloud Hospital Score
3rd Quarter 2008 to 2nd Quarter 2011 |
National Rate
|
Heart Attack 30-Day Readmission Rate
(A lower number is better.) |
19.3% |
19.7% |
Quality Measure:
Congestive Heart Failure |
St. Cloud Hospital Score
3rd Quarter 2011 to 2nd Quarter 2012 |
Minnesota
Average
|
| Discharge Instructions: Patients who are given instructions about follow-up care and treatment. |
92% |
87% |
| Assessment of Left Ventricular (Heart) Function: Patients who have an assessment of the heart's ability to pump blood effectively. |
100% |
97% |
| ACE Inhibitor at Discharge: Patients who are discharged on ACE inhibitors for treatment of their heart failure. |
100% |
94% |
Quality Measure:
Mortality Rate: Congestive Heart Failure |
St. Cloud Hospital Score
3rd Quarter 2008 to 2nd Quarter 2011 |
National Rate
|
Congestive Heart Failure 30-Day Mortality Rate
(A lower number is better.) |
9.9% |
11.6% |
Quality Measure:
Readmission Rate: Congestive Heart Failure |
St. Cloud Hospital Score
3rd Quarter 2008 to 2nd Quarter 2011 |
National Rate
|
| Congestive Heart Failure 30-Day Readmission Rate
(A lower number is better.) |
23.6% |
24.7% |
Quality Measure:
Pneumonia |
St. Cloud Hospital Score
3rd Quarter 2011 to 2nd Quarter 2012 |
Minnesota
Average
|
| Blood Cultures Performed in the Emergency Department prior to antibiotic received in the hospital. |
99% |
96% |
| Initial Antibiotic Selected for Community-Acquired Pneumonia |
97% |
93% |
Quality Measure:
Mortality Rate: Pneumonia |
St. Cloud Hospital Score
3rd Quarter 2008 to 2nd Quarter 2011 |
National Rate
|
Pneumonia 30-Day Mortality Rate
(A lower number is better.) |
10.6% |
12.0% |
Quality Measure:
Readmission Rate: Pneumonia |
St. Cloud Hospital Score
3rd Quarter 2008 to 2nd Quarter 2011 |
National Rate
|
Pneumonia 30-Day Readmission Rate
(A lower number is better.) |
20.2% |
18.5% |
Quality Measure:
Surgical Infection Prevention |
St. Cloud Hospital Score
Apr.-June 2012 |
Minnesota
Average
|
| Antibiotic Before Surgery: Patients who received their antibiotic within one hour of incision time. |
99% |
98% |
| Antibiotic After Surgery: Patients who had their antibiotic discontinued within 24 hours of their procedure (this is the desired practice). |
97% |
98% |
| Glucose Level After Cardiac Surgery: Cardiac surgery patients with normal early morning glucose after heart surgery. |
91% |
94% |
| Normal Body Temperature: Patients with normal body temperature after surgery. |
100% |
99% |
| Antibiotic Selection: Appropriate choice of antibiotic for infection prevention. |
99% |
98% |
| Beta Blocker Therapy: Patients on beta blocker medication before admission who received it during their surgical experience. |
98% |
97% |
| Treatment to Prevent Blood Clots: Patients who received treatment to prevent blood clots. |
98% |
98% |
| Treatment to Prevent Blood Clots: Patients who received treatment to prevent blood clots within 24 hours before and after surgery. |
98% |
97% |
| Urinary Catheter Removal: Patients with urinary catheters removed on the first or second day after surgery. |
83% |
94% |
Quality Measure:
Emergency Department |
St. Cloud Hospital Score
3rd Quarter 2011 to 2nd Quarter 2012 |
Minnesota
Average
|
| Median time from emergency department arrival to emergency department departure for admitted emergency department patients. |
205 minutes |
199 minutes |
| Admit decision time to emergency department departure for admitted patients. |
70 minutes |
60 minutes |
Quality Measure:
Immunizations |
St. Cloud Hospital Score
3rd Quarter 2011 to 2nd Quarter 2012 |
Minnesota
Average
|
| Pneumococcal (Pneumonia) Immunization |
93% |
86% |
| Influenza (Flu) Immunization |
93% |
86% |
Other Relevant Quality Measures
Quality Measure:
Vent-Acquired Pneumonia |
St. Cloud Hospital Rate
July-Sept. 2012 |
National Target |
For adult patients in the Intensive Care/Critical Care Units.
Patients on ventilators are at high risk for developing pneumonia. This inhibits the ability to wean the patient from the ventilator. (A lower number is better.) |
0.0 per 1,000 ventilator days
|
Average is 0.3 per 1,000 ventilator days |
For pediatric patients in the Pediatric Intensive Care Unit.
Patients on ventilators are at high risk for developing pneumonia. This inhibits the ability to wean the patient from the ventilator. (A lower number is better.)
|
0.0 per 1,000 ventilator days |
Average is 0.0 per 1,000 ventilator days |
Quality Measure:
Overall Trauma Survival Rate |
St. Cloud Hospital Trauma Survival Rate
Calendar Year 2011 |
National Trauma Survival Rate
2011 |
Survival rates for trauma patients admitted to
St. Cloud Hospital. |
97.53% |
95.79% |
Quality Measure:
Central Line Blood Stream Infection Rate |
St. Cloud Hospital Infection Rate
July-Sept. 2012 |
National
Average |
For patients in the adult Intensive Care Unit.
Patients with central line catheters are at high risk for developing blood stream infections. The goal is to be at zero. |
0.0 infections
per 1,000
catheter days
|
0.8 infections
per 1,000
catheter days
|
Quality Measure:
Central Line Blood Stream Infection Rate |
St. Cloud Hospital Infection Rate
July-Sept. 2012 |
St. Cloud Hospital Target |
For all patients in St. Cloud Hospital.
Patients with central line catheters are at high risk for developing blood stream infections. The goal is to be at zero. |
1.4 infections
per 1,000
catheter days
|
0 infections
per 1,000
catheter days
|
Quality Measure:
Urinary Catheter Infection Rate |
St. Cloud Hospital Infection Rate
July-Sept. 2012 |
St. Cloud Hospital Target |
| Hospital-acquired infection related to the presence of a urinary drainage tube. (A lower number is better.) |
5.1 infections
per 1,000
catheter days
|
0 infections
per 1,000
catheter days
|
Hospital Compare Web Site
The U.S. Department of Health and Human Services has a web site known as "Hospital Compare," where you may learn about and compare hospitals in Minnesota as well as those across the country. The data shown above for St. Cloud Hospital is more recent than the data shown on the Hospital Compare site.
To learn more, please visit the Hospital Compare web site.
HCAHPS Survey of Patients' Hospital Experiences
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national, standardized survey of hospital patients. HCAHPS (pronounced "H-caps") was created to publicly report the patient’s perspective of hospital care. The survey asks a random sample of recently discharged patients about important aspects of their hospital experience.
Learn more about the HCAHPS survey
Minnesota Hospital Quality Report
The Minnesota Hospital Quality Report web site, developed by the Minnesota Hospital Quality Partnership, includes information on quality of care and patient experiences at Minnesota hospitals.
The Minnesota Hospital Quality Partnership includes the Minnesota Hospital Association and Stratis Health, Minnesota’s Quality Improvement Organization.
To learn more, please visit the Minnesota Hospital Quality Report web site.
Joint Commission Quality Check
The Joint Commission created a web site that serves as a source of hospital accreditation information.
To learn more, please visit the Quality Check web site.
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