Survey Results for St. Mary Mercy Hospital

In the Annual Volume Results column, the lower bar always represents the Coalition's recommended volume and the upper bar always represents the hospital's volume. The actual volume numbers are displayed below the bars.

Click the links in the Treatment Area column to view the survey results for a specific treatment.

Treatment Area	Activity Results	Annual Volume Results
Open Heart Surgery	n/a
Percutaneous Coronary Intervention	•••	135 (actual volume) 400 (coalition threshold)
Abdominal Aortic Aneurysm Repair	••	10 (actual volume) 20 (coalition threshold)
Carotid Endarterectomy Surgery	••	44 (actual volume) 50 (coalition threshold)
Esophagectomy	•••	3 (actual volume) 7 (coalition threshold)
Low Birthweight Infants	n/a
Infants with Congenital Anomalies	n/a
Intensive Care Unit Physician Staffing (IPS)	••••	n/a

Hospital Comments

Root Cause Analisys	The Quality and Patient Safety Committee track and monitor recommendations until implemented
General Comments on Patient Safety Activities	Falls reduction Keystone ICU SBAR communication Universal Protocol hospital-wide Time-out before use of electrocautery and alcohol prep FMEA for all new service lines Rapid Response Team Prophylactic Antibiotic Standardized process Verbal Order Read Back Nursing Quality Indicators

Survey Results for St. Mary Mercy Hospital

Treatment Area

Activity Results

Annual Volume Results

Hospital Comments

Root Cause Analisys

General Comments on Patient Safety Activities