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Do you know what an SIR is?

November 5th, 2017 Leave a comment Go to comments

I am both a retired RN and a healthcare consumer.  I have attended dozens of meetings about Hospital and Healthcare associated infections, or HAIs. I do this because I think it is essential that healthcare consumers (simpler term is PATIENTS) should have a voice in the decisions surrounding HAI prevention, transparency, reports and policy, and over the past decade, the State and Federal governments came around to believing the same thing.  I am an official member of the State of Maine CDC HAI collaborative and I represent consumers.   A few days ago there was a member of the public in our meeting  I tried to listen to the conversation through her  ears.

This is what happened.   Right off the bat, acronyms were used that she, and possibly others in the group do not understand.  Beyond that, some of those acronyms are used in public reports.

It isn’t intentional when professional infection prevention professionals speak in complicated lingo, it is their everyday language.  But, when consumers are part of the conversation, the very least that could be offered is a printed glossary of terms for newcomers, and for some of the people around the table who do not do this work every day, like me and a few others.  I know for a fact that other regular members of our collaborative don’t understand all of those acronyms or terms that are tossed about during our meetings. .

So, what exactly is an SIR?  It is an acronym for “Standard Infection Ratio“. It is a way that the CDC, both State and national, reports infection rates.  The SIR is a risk adjusted number that is reported that includes the number of expected infections,  by facility or by State, or Nationally.  For example, if a big trauma center that accepts the most complicated patients has a higher number of “expected” infections, that is somehow formulated into their SIR. There is also a risk adjustment for teaching hospitals.   WHAT???!!!!   The actual number of infections is not reported when using an SIR.  The mean is the number 1, and anything under 1 like .48 is on the better side of 1 and anything above 1 , like 1.4,  is on the worse side.  Under 1 means fewer infections, and over 1 means more infections. Contrary to most reports, a higher score does not mean a better score.   So, is that now as clear as mud?   After all my years of these meetings, I’m still not 100% sure this explanation is totally accurate, but it is close enough.

So, what does having an SIR in an infection report mean?.  Well, one thing that it means is that Hospitals (or entire States)  can actually HAVE an expected number of infections and that is figured into their SIR report.  That is how the final reported SIR numbers are risk adjusted.   REALLY??  It seems to me  that expected number of infections should always be ZERO….always.   Zero expected infections is exactly what I and I assume all patients expect from any Hospital, so why can they have anything above that as an expectation, no matter what or who their patient population is.  I know this will stir up some discussion and anger from the larger hospitals that claim they care for all the most complex patients, but they also have the resources, the staff (we hope!), and the experts that smaller facilities do not.  And, it is their job although challenging, to keep all of their patients infection free. Nobody ever said elimination of infections would be easy.

This incomprehensible methodology is routinely used to create public reports on infections.  Then the experts who create these muddy reports have the nerve to say that patients do not understand infection reports.  Of course they don’t. A lot of doctors and nurses don’t understand them either.  They don’t know what an SIR is.  Creating a report that even some professionals don’t understand is a disservice to patients and consumers.  How about this approach for a change?  Report actual numbers, not SIRs.  For example,  report the number of hysterectomies the hospital performs every year, and the number of those patients who get a surgical site infection (SSI) as a result.   Hospital A does 1500 hysterectomies (all varieties) every year, and 3 patients get an SSI.  Or, Hospital B performs 50 such surgeries and 3 patients get an SSI. Even with my limited mathematical skills, I can figure out which hospital generally gets the best results regarding infections.   This type of report is useful in two ways.  It gives the volume of procedures done, and it also gives the number of infections that occur, both very important pieces of information for patients.  As a patient, I don’t particularly appreciate or understand “risk adjustments” that help hospitals have a better infection report, I just want to know exactly what my personal risk is with a particular facility, doctor or surgeon.

If Hospitals and entire States are going to publicly report infections, as they absolutely should, make the report useful to everyone, not just to infection prevention professionals and other savvy experts, who actually understand these wonky reports.  Consumers will use that public information to make choices that could very well affect their lives and pocketbooks.   Preventable infections cause horrible suffering and sometimes death,  and they can tack on a huge amount to an already high hospital bill.  We want clear, accurate and easy to understand information about infections.  Creating a public report that only infection professionals can decipher is not really a public service.  It only serves the experts who can understand it.

This has been my brief but spectacular explanation of and opinion about the SIR!







  1. Raye
    April 22nd, 2018 at 08:09 | #1

    It would seem that a metric system of this type was intended to obfuscate the facts for all but those with privilege. Each culture develops a specialized language known only to them. Medical practitioners and lawyers spring to mind, but there are thousands. Maybe millions. Such languages are designed to identify “us” from “them”. Messages in code are not intended for the layperson.

  2. Rebecca M Krall
    June 2nd, 2018 at 07:14 | #2

    I appreciated your identification and explanation of SIR. I come to health care advocacy from what I call a layman’s (or is that laywoman’s?) perspective after being thrown into the position of caregiver for a loved one with bacterial meningitis – early signs of the infection that were missed by three different health care providers before it quickly progressed to an overwhelming post-splenectomy infection. Today, I am keenly aware of the dangers of infections spread in hospitals. My loved one developed a secondary MRSA infection in the toes during a long stay in the ICU because of a bacterial infection caused by a different drug resistant bacterium. Talking with many specialists required a translator, a family member that was a nurse practitioner, and many hours of researching specific issues my loved one faced. No one had any answers. Every response was, “we’ll have to wait and see.” Difficult medical language only exacerbated the issue of understanding. I was willing to seek definitions for terms I did not understand and ask for explanation from our many doctors, but many other caregivers and patients do not feel confidence in doing so. Unfortunately, professional language is what separates one profession from another. In science education we face the same issue. In fact, professional language – particularly acronyms – can make it difficult to understand differences even across science disciplines. Professionals from any discipline often fall into their use of professional language as it is requried in their training and extends into the profession. Terms used in a layperson’s language often assume a different meaning in professional language. This further confuses the issue in speaking to a diverse group composed of individuals from different professions. Many of us need to be reminded to make our language clear to those outside our profession in order promote clearer communication.

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