Hospitals Make Steady Progress in Patient Safety: Study

Mark Crane

May 06, 2014

Hospitals are making steady incremental improvements in patient safety, but some nationally recognized institutions are among the poor performers, according to a new report by the Leapfrog Group.

Nearly one third of the 2522 surveyed general hospitals have seen a 10% or higher improvement in performance since 2012, according to the spring 2014 update to the Leapfrog Group's Hospital Safety Score, which assigns grades to hospitals on the basis of their ability to prevent errors, injuries, and infection.

The survey shows that 804 hospitals earned an "A," 668 hospitals earned a "B," 878 earned a "C," 150 earned a "D," and 22 earned an "F." Five states had zero hospitals receiving an "A" in this study, including Alaska, the District of Columbia, Idaho, Nebraska, and Wyoming.

Maine once again was at the top of states, with the highest percentage of "A" hospitals, at 74%. Some 53 hospitals changed by 2 or more grades, showing either a significant improvement or significant decline.

The Leapfrog Group, a not-for-profit organization that represents large employers and other purchasers of healthcare, documented that the majority of the improvements were a result of hospitals improving their processes and safe practices, such as hand hygiene, improved staffing levels and training for nurses, and administering the correct antibiotics before surgery.

"We were very pleasantly surprised that there was a 6.3% overall improvement in hospital performance since 2012," Leah Binder, president and chief executive officer of the Leapfrog Group, said in an interview with Medscape Medical News. "That may not sound dramatic, but there has been almost no improvement in safety before that period."

"It was disappointing to see that some big-name hospitals continue to lag behind in safety," she said. For example, Dartmouth-Hitchcock Medical Center in New Hampshire, Mount Sinai Medical Center in New York City, the Cleveland Clinic in Ohio, Intermountain Medical Center in Salt Lake City, Utah, and Henry Ford Hospital in Detroit, Michigan, all had "Cs" in the ratings.

"While these hospitals often receive accolades for their surgical teams, state-of-the-art equipment and sought-after physicians, they don't make the grade when it comes to patient safety," Binder said. "An institution could have the best surgeons in the world, but if the aftercare is lacking and the patient develops an infection as a result, then the hospital has failed to protect its patient."

Leapfrog's panel of medical experts selected 28 measures of publicly available hospital safety data from Centers for Medicare & Medicaid Services' Hospital Compare, the American Hospital Association, and the Leapfrog Group's annual hospital survey. The hospital safety score was based on process measures, representing how often a hospital gives patients recommended treatment for a given medical condition or procedure; structural measures, such as whether a hospital uses a computerized physician order entry system to prevent medication errors; and outcome measures, representing what happens to a patient while receiving care.

Appropriate Methodology?

An article from the Journal of Hospital Medicine, published online January 13, argued that Leapfrog's scoring system is biased against the nearly 50% of the hospitals that did not participate in its survey. Of the nation's most prestigious hospitals, those who participated in the survey received an average grade of A, whereas those who did not participate received an average grade of B, the article said.

Binder countered that the data in the Journal of Hospital Medicine study were not statistically significant. "The study is badly flawed. There are hundreds of hospitals who got an A that didn't participate in the Leapfrog study," she said. "If the authors had checked with us about our methodology, this would have been easily clarified."

Leapfrog's methodology may differ in some ways from that of other hospital rating organizations, such as US News & World Report, Healthgrades, and Consumer reports.

In an earlier interview with Medscape Medical News on hospital ratings, Matt Austin, PhD, from the Johns Hopkins Armstrong Institute for Patient Safety and Quality in Baltimore, Maryland, said, "The lack of agreement among national hospital rating systems is likely explained by each system using its own rating methodology, each having a different focus to their ratings, and each stressing different measures of performance."

Leapfrog and Consumer Reports scores focus on hospital safety, but each defines safety differently, he explained. US News & World Report focuses strictly on the best medical centers for the most difficult patients, whereas Healthgrades focuses on general hospital quality.

"Hospital rating systems use a variety of methods for distinguishing 'high performers' from 'low performers,' often creating the paradox of hospitals simultaneously being considered best and worst, depending on the rating system used," Dr. Austin said.

"While the lack of agreement among these rating systems is largely explained by their different foci and measures, these differences are likely not clear to many physicians and patients," he said.

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