From the Commissioner

Welcome to the New Jersey 2011 Hospital Performance Report, the New Jersey Department of Health eighth annual report on the quality of care in New Jersey hospitals.

Improving patient safety and ensuring high quality health care are top priorities of the Department of Health. All of our licensed health care facilities strive every day to reduce medical errors and healthcare-associated infections (HAIs) and to ensure that every patient receives the highest standards of care. Educating consumers about the performance of the facilities where they receive care is equally important because it empowers them to make informed decisions.

Closely following the federal government’s yearly expansion of quality measures, the Department has added the following measures to this year’s report:

• A Surgical Care Improvement Project (SCIP) measure
• Three HAI measures:
  • Catheter-Associated Urinary Tract Infection (CAUTI)
  • Two Surgical Site Infection (SSI) measures: SSI after Coronary Artery Bypass Graft(CABG) Surgery, and SSI after Abdominal Hysterectomy

The report still contains the same measures for:

• Recommended Care: heart attack, pneumonia, surgical care improvement project (SCIP) and heart failure
• 12 Patient Safety Indicators (PSI) mandated by law, and
• HAI measure for Central Line-Associated Blood Stream Infection (CLABSI), also required by legislation

All the measures in this report are based on scientific evidence and research performed at the national level. The data is from 2010 except for the two new SSIs, which are based on 2009 data.

The Quality Improvement Advisory Committee (QIAC) is instrumental in developing this report and provides guidance to the Department on quality initiatives. QIAC members, who are leaders from the New Jersey hospital industry and health care providers, volunteer their energy and skills to advise the Department on high quality health care programs. These programs have helped position New Jersey in the forefront of other states.

For more data, consumer tips and other health care information, visit our web site at www.nj.gov/health/hpr. Learn about:

• How to prevent HAIs while in the hospital
• What you can do before having surgery to help prevent medical errors, and
• Tips on how to choose or locate a doctor in New Jersey

I hope you find the report useful. Please feel free to send us your feedback on the report or the web site at

Mary E. O’Dowd, MPH
Commissioner
Department of Health