Leapfrog: Hospital dangers still lurk

July 23, 2014 in Medical Technology

On the up side, more hospitals are adopting computerized physician order entry, which has proven to reduce medication error. On the down side, hospitals can’t seem to get a handle on certain hospital-acquired infections.

The benefits – and dangers – of hospital stays are highlighted in the most recent report from healthcare watchdog organization Leapfrog in “Results of the 2013 Leapfrog Hospital Survey,” which it completed with Castlight.

More than 1,400 hospitals participated in the survey – 1,437, to be exact, a record number, according to Leapfrog, and one that adds up to 37 percent of hospitals nationwide.

Leapfrog called attention to hospital systems with 100 percent participation across their systems. Among them were HCA Healthcare, Kaiser Permanente, Tenet Healthcare, Sutter Health, Steward Health Care, Orlando health, Baylor Health, and many more.

All of Maine’s 36 hospitals responded to the survey, making it the sole state in the nation to achieve 100 percent participation.

“The Leapfrog Hospital Survey tells an important story about the performance of hospitals. We’ve commissioned this report on behalf of our membership of employers nationwide, so we can tell that story to American families and help people select the best hospitals,” said Leah Binder, president and CEO of Leapfrog, in releasing the findings of the survey. “The stakes couldn’t be higher. Hospital errors remain the third leading cause of death in the U.S., so we want patients and purchasers to put safety first.”

[See also: Leapfrog grades hospitals A to F on patient safety.]

“The Leapfrog Hospital Survey is in line with Castlight’s interest to bring greater transparency to U.S. healthcare costs, quality and outcomes,” Jennifer Schneider, MD, vice president of Strategic Analytics for Castlight Health, added, in a statement. “We are pleased to bring our analytics capabilities to bear for this important project and to help identify quality and safety findings and areas for progress within the U.S. hospitals that participated in the survey.”

[See also: Rural hospitals rule on Leapfrog list.]

Here are the key findings from the survey:

  • Hospital participation is increasing: A record number of hospitals submitted a survey this year: 1,437 hospitals or 37 percent of hospitals nationwide.
  • More hospitals are adopting computerized physician order entry to reduce medication errors: This is good news because CPOE has been shown to reduce medication errors by upwards of 55 percent, and medication errors are the most common errors occurring in hospitals. Although hospitals and their CPOE systems are doing a better job detecting potential medication errors, it’s troubling that not all CPOE systems give appropriate warnings for orders that might have tragic consequences for patients.
  • Maternity care remains a key area of improvement: While hospitals overall improved in the area of maternity care – especially in reducing early elective deliveries – problems remain persistent and many hospitals still lag behind. Episiotomy rates continue to decline, but show substantial room for improvement, and there is only moderate improvement in the number of hospitals taking the necessary precautions to reduce harm to mothers and babies.
  • Hospital performance on Leapfrog’s high-risk deliveries standard has declined: Too many very low birth-weight babies are being delivered at hospitals that aren’t optimally equipped to care for them, and the problem is growing.
  • Significant variation in survival rates for high-risk procedures: We still see significant variation in predicted survival rates for high-risk procedures across hospitals, suggesting it is wise for consumers to research Leapfrog Hospital Survey results when considering one of these procedures. For abdominal aortic aneurism repair there is a seven-fold difference between the predicted survival at the best performing hospital and the predicted survival at the worst performing hospital. For pancreatectomies the predicted mortality rate varies from 0 percent to almost 21 percent, while for esophagectomies the predicted mortality rate varies from 2.5 percent to 12 percent. The predicted survival rates for aortic valve replacement show the smallest variation.
  • Rates of certain hospital-acquired conditions remain problematic: Variation in hospitals’ ability to reduce and eliminate certain hospital-acquired conditions remains. Among hospitals that reported on hospital-acquired injuries, infections and pressure ulcers, rates varied tremendously. One in six Leapfrog reporting hospitals have higher infection rates than expected for central line infections and one in ten perform poorly in preventing catheter-associated urinary tract infections.
  • Hospitals are preventing deaths in the ICU with appropriate physician staffing: Hospitals with intensive care units are in better compliance with Leapfrog’s ICU Physician Staffing standard to decrease mortality. Studies show that meeting the Leapfrog standard for physician staffing can decrease mortality in the ICU as much as 40 percent
  • Never Events Policy compliance holding steady: The number of hospitals meeting Leapfrog’s Never Events Policy standard is holding steady.
  • Compliance with safe practices: While compliance with The National Quality Forum-endorsed safe practices is generally high among hospitals, urban hospitals are performing better than rural.

Access individual hospital results here.

Access the survey here.

Download survey materials here.

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