Which Israeli hospitals give the best quality care?

The annual National Program for Quality Indicators report that aims to evaluate and examine the quality of medicine in the country’s hospitals also showed that although there was a decrease in the volume of activity of most of the indices it measures in 2020, compliance rates did not largely decline – and in some cases even improved. 

“The coronavirus changed the face of the health care system in 2020 and led to a focus on fighting the virus, without compromise and without fear,” wrote Prof. Chezy Levy, former Health Ministry director-general, in a letter opening the report. “Although there was a certain decrease in elective and ambulatory activity at the beginning of the pandemic, it was not so in the achievements of the hospitals, mother and baby centers or ambulance companies, which maintained and even advanced the targets of the indices.”

He said that the quality “goals are updated each year and challenge service providers to maintain an annual quality improvement program. The measurement is comparative between the various institutions and is a source of positive and constructive competitiveness, an incentive for excellence and achievement.”

The report ranked Meir Medical Center in Kfar Saba and Carmel Medical Center in Haifa as tied for No. 1 for large hospitals and Hadassah’s Mount Scopus branch as No. 1 for small hospitals. 

 
The hospitals that ranked lowest were Mayanei HaYeshua Medical Center in Bnei Brak, Laniado Hospital in Netanya, Wolfson Medical Center in Holon and Shamir Medical Center in Be’er Yaakov.

Hospitals are ranked on a scale of one to 10, with 10 points being the highest. Institutions can achieve fractions of points. All the country’s general hospitals received scores of more than nine points.

The report also ranks geriatric centers, psychiatric facilities and mother and baby programs, known in Israel as Tipat Chalav.

Because of the pandemic, the report explained that many countries failed to track hospital quality measurements and that thus far, to the best of the ministry’s knowledge, no studies have yet been published showing the effect COVID-10 on quality indicators at the national level. For example, in the United States, the Centers for Medicare & Medicaid Services suspended data collection and reporting under their own quality indicators program. 

In Israel, the program was maintained despite the crisis and has therefore made it possible to analyze the impact of coronavirus on dozens of broad and specific quality indicators. However, the report noted that this year some of the targets were not measured due to the difficulty created by the crisis that led to a decline in the functioning of hospitals throughout 2020, especially the internal medicine wards.

Here is some of what the report found:

The rates of compliance with the catheterization index within 90 minutes in an acute cardiac event and the median time index until the patient’s triage in the emergency room remained stable.

Improvements were seen in the rate of compliance with the index to repair hip fractures within 48 hours, as well as to administer prophylactic antibiotics quickly during colon, cesarean and hip fracture surgeries. 

Also, the median time until a CT scan is performed on a patient who is suspected of having a stroke improved by a full minute, from 28 minutes in 2019 to 27 in 2020. 

On the other hand, there was a 21% decrease in conducting a risk assessment for thrombosis in a vein, something which is done in internal medicine departments, and a 14% decrease in conducting a  diagnostic imaging evaluation of the patient with transient ischemia at high risk of stroke.

Among the possible reasons for this is a decrease in the number of referrals to the hospital  and that many internal medicine departments were shuttered to allow these doctors to serve COVID-19 patients.

Given how prone the eldery population is to severe COVID-19, geriatric hospitals were greatly affected by the pandemic. In 2020, there was a significant decrease of 10% to 25% in the volume of activities of all indices, while these facilities focused on keeping their residents and patients safe from the virus. 

For example, there was a significant decrease in carrying out nutritional, diabetic foot and depression assessments. Moreover, there was a significant decrease in the volume of rehabilitation-related measures at these hospitals, including functional assessments, vitamin D recommendation and delirium assessment. Here, too, this is probably due to a preference to perform rehabilitation outside of hospital settings as much as possible during the pandemic.

At psychiatric and mental health hospitals, activity was also on the decline. Risk assessments for psychiatric emergency violence fell by 7% and having follow up appointments in the community after release also decreased by 7%. Most acute was holding meetings between a doctor and family of a hospitalized child within five days of admission, which dropped by 16% – largely, the report said, because this index requires a face-to-face meeting, which was sometimes not possible due to lockdown or isolation of family members.

Apparently, the main reason that caused a decrease in the activity of these indices is a decrease in requests for psychiatric emergency care and consequently also a decrease in the number of hospitalizations in mental health hospitals during the pandemic, the report explained. 

The Tipat Chalav program, however, saw only a small decline in activity – about 3%. And, the rate of compliance remained stable or improved. 

Indices that showed improvement: Administration of the pertussis vaccine – improved by 2%;  (% 2), administration of the pentavalent vaccine that contains diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b improved by 1%; and helping mothers maintain exclusive breastfeeding increased by 1%. 

The rate of compliance of ensuring a mother brings her baby for an initial assessment within two weeks of birth remained stable. “Taking the lead in the quality indicators for the second year in a row is the result of the excellent medical care and the hard work of all the staff at the hospital,” Beilinson Director-General Dr. Eitan Wertheim said. “I am proud to lead a professional and determined team.”