The nice thing about the City Council being on August break is that I get to write about topics that often get shunted to the side because the City Council issues are always seem to suck my attention away. And again, my attention turns toward the Alameda Hospital. It is a subject I am fascinated by because I don’t really have a strong feeling about whether it should stay open or whether it should close. Selfishly, the closure of the hospital and stopping the parcel tax would probably benefit me more since I don’t use the Hospital and probably won’t use the Hospital, but there are a lot of services and programs that I pay for with my tax dollars that I don’t get the use out of either.
So I’m taking this opportunity to discuss the puzzling opposition by Alameda Hospital detractors and one Board Member to Alameda Hospital getting certification as a stroke center. Right now, Alameda Hospital is not currently certified by the Joint Commission, an accreditation organization, as a stroke center, but it is in the process of becoming accredited. There is a fairly rigorous set of hoops that must be jumped in order to be accredited by the Joint Commission, aka they don’t give these away in boxes of cereal.
However, despite not being a certified stroke center Alameda Hospital can accept stroke patients. Now we can argue about whether it is better to get to a hospital first or to be routed to a certified stroke center first, but that isn’t the point of this post. The answer to that question, I imagine, is rather gray and fuzzy depending on which professionals you talk to.
Some hospital detractors, including one Hospital Board member, has explicitly stated that he believes that Alameda Hospital working toward stroke certification through the Joint Commission is a mistake. In a question and answer on In Alameda, the question was specifically asked about Alameda Hospital’s attempt to get certified by the Joint Commission, the answer Elliott Gorelick gave:
The problem with acute stroke care at Alameda Hospital is that there are larger and more well-equipped hospitals close by. Because these alternative hospitals are so close there is no evidence in the literature that the relatively small time differential in reaching them is likely to have any negative effect on patient outcomes, but there is evidence that the additional services, resources, and expertise are likely to have beneficial effect.
Many studies show that larger volume of cases means better outcomes, not just for stroke but for a whole host of conditions. There are also several studies that show that even after stroke certification is obtained, reported outcomes follow the trend of outcomes prior to stroke certification — subpar hospitals have subpar outcomes even with PSC (Primary Stroke Certificaton).
Finally based on what I have read, I believe acute stroke care is a dynamically changing landscape that requires resources that Alameda Hospital does not have nor can afford.
If I put this all together, I draw the conclusion that the limited volumes and interventions that Alameda Hospital will have available to them (which will lead to poorer patient outcomes) does not compensate for the additional training and documentation associated with PSC (which should lead to better patient outcomes). Since PSC will drive patients to Alameda Hospital and away from the likely better alternative hospitals close by (but farther than Alameda), the net result will be “worse health outcomes for [Alamedans].”
So it’s not that Alameda Hospital doesn’t provide perfectly good or even perfectly adequate stroke care, it’s that someone else can do it better because they are bigger. Unless of course, Boardmember Elliott Gorelick is accusing Alameda Hospital of being a “subpar hospital” thereby providing “subpar outcomes.” But of course how Alameda Hospital is “subpar” is never explained other than it just being small.
For me, it appears the opposition to Alameda Hospital being certified as a stroke center is to keep it from being competitive with surrounding hospitals. The biggie is that Alameda County Emergency Services protocol does not allow ambulances to route stroke patients to hospitals without this stroke center designation. Keeping potential patients away from Alameda Hospital is one way to ensure that it cannot raise any revenue beyond the parcel tax and thereby make the argument that the Hospital must be closed down.
I did find this one blog which recounted a debate at the International Stroke Conference in February this year which examined the question of whether the “Stroke Care” label improves outcomes. On one side one doctor:
…cited lots of evidence over many years showing higher rates of using clot-busting drugs, lower death rates, and less need for institutionalization when patients were treated in stroke units compared with other hospital care.
But the blogger notes than many of these studies were conducted before the Joint Commission began certifying stroke centers. On the other hand another doctor:
…agreed that care is better at Primary Stroke Centers, but argued that these were the centers that already were excelling at stroke care and working hard to improve stroke care, and so they applied for and earned the Primary Stroke Center labels. There’s no evidence that the label itself improved outcomes at those centers.
Essentially, if a Hospital is good enough to get the certification, then it’s probably doing a damn fine job already.
For me, it seems pretty obvious that it’s just good practice to get stroke center certified, regardless of whether the Hospital closes in 1 year or 100 years from now, there doesn’t appear to be anything negative for current and existing patients if Alameda Hospital achieves this benchmark.