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Summary of Hospital Quality Measures

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HackensackMeridian Health, Mountainside Medical Center
http://www.mountainsidehosp.com

Hospital is not licensed to perform CABG surgery.

Recommended Care/Process of Care Measures
Higher Score is Better
  Hospital
Overall Score
State Median State Top 10%
Heart Attack (detail) 86 95 100
Pneumonia (detail) 100 99 100
Surgical Care Improvement (detail) 100 99 100
Heart Failure (detail) 100 100 100


Outcome of Care Measures: Mortality Inpatient Quality Indicator (IQI)
Lower Rate is Better
Hospital Rate National Average Rate (2016) Statewide Average Rate (2017)
Heart Attack 9.1 5.1 11
Pneumonia 4.1 2.8 3.6
Heart Failure 1.3 2.7 3.7
Stroke 5.3 7.4 5.9


Patient Safety Indicators
Lower Rate is Better
Hospital Rate National averages (2016) Statewide number of adverse events (2017) Statewide average rates (2017)
Retained Surgical Item or Unretrieved Device Fragment 0 694 16 NA
Iatrogenic pneumo thorax 0.2 0.2 113 0.2
In Hospital Fall with Hip Fracture 0 0.1 35 0.1
Post-operative hemorrhage or hematoma 0.6 2.3 348 2.1
Post-operative pulmonary embolism (PE) or deep vein thrombosis (DVT) 4.3 3.4 698 4.1
Post-operative sepsis 1.5 4 296 3.7
Post-operative wound dehiscence 2.5 0.7 27 0.6
Unrecognized Abdominopelvic Accidental Puncture or Laceration 0 0.7 99 0.9
Birth Trauma+ 2.6 4.6 206 2.2
Obstetric trauma - vaginal delivery with instrument+ 225.8 109.9 429 109.4
Obstetric trauma - vaginal delivery without instrument+ 31.2 17.3 843 14.6

+ Observed rate (not risk-adjusted)

Not applicable - Rate is not applicable for "Retained Surgical Item or Unretrieved Device Fragment Count" and "Transfusion Reaction". Both indicators are measured using volume instead of rate.




Healthcare Associated Infections (HAIs)
  Hospital to
National Comparison‡
Standardized Infection Ratio (SIR) NJ Statewide to
National Comparison
No Measures to display.

Health System: Meridian Health System
Outpatient measures for all hospitals [pdf 20k]
Healthcare Associated Infections (HAI) for all hospitals