Hawaii is the second worst in the nation for patient safety during hospital surgeries but has the lowest number of breast and prostate cancer deaths, according to a recent federal government report on health care quality.

The 2011 National Healthcare Quality Report released by the U.S. Department of Health and Human Service ranked each state based on whether recommended care practices were used.

"With any of the measures, what we’re working on with our hospitals and continuum of care is that we very carefully look at areas that need improvement," said Susan Young, director of quality and regulatory affairs at the Healthcare Association of Hawaii. "This helps you identify areas that need improvement. That’s very important that we have areas we can look at, and hospitals can put very specific measures in place."

The low patient safety score was based on Hawaii hospitals’ score for using appropriate antibiotics to help prevent wound infection after surgery, providing antibiotics within one hour of surgery and discontinuing antibiotics on time.

Wyoming was the only state that ranked worse than Hawaii in patient safety during surgeries, according to the report, which was issued last month and based on more than 150 quality measures.

Hawaii also received poor ratings for the care of pneumonia patients in hospitals as well as hospice patients who received the right amount of pain medication and the number of patients receiving kidney transplants. In overall health care quality, Hawaii ranked in the middle at No. 24 among the states and Washington, D.C.

"There’s a pattern with hospitals having problems," said Ernest Moy, lead author of the report. "Hospitals are not adhering to recommendations, or they’re not documenting them. It could be that people in Hawaii, a lot of times they might be getting antibiotics but might not get the ideal antibiotic or might not get it at the right time."

Other studies have scored the state poorly on hospital-based patient care in general, he said.

"They are on the worse 20 percent or so for many of the measures," Moy said. "There seems to be more problems in the hospitals as opposed to doctors’ offices. I would suggest Hawaii’s policymakers take a look at hospital care and hospice."

However, the state had the lowest number of breast and prostate cancer deaths and low rates of hospitalization for what is considered avoidable conditions including pneumonia, influenza and diabetes.

"Some of the things Hawaii does well in may be related to the large Asian population, which typically has lower (cancer) death and hospitalization rates," Moy said. "Hawaii has fairly good health insurance coverage, which could also lend itself to low rates of hospitalization for these avoidable conditions."

The Healthcare Association of Hawaii said it has developed a Quality and Patient Safety Committee including providers and public health officials who meet regularly to help medical facilities develop and share best practices to improve patient care.

The report is based on hospital data from the Centers for Medicare and Medicaid Services.