Patient Safety Awards Hold Hospitals Accountable

By John Palmer

The Leapfrog Group, a national patient safety advocate that ranks U.S. hospitals annually using a report card-like system of letter grades, finds that the risk of death doubles for patients who use hospitals ranked as a “D” or “F” on Leapfrog’s scale.

That’s among the latest results from this spring’s Leapfrog Hospital Safety Grade results, which were released in May.

The survey’s results assessed more than 2,600 hospitals receiving a Hospital Safety Grade and found the following when compared to hospitals getting an “A” grade:

  • Patients at “D” and “F” hospitals face a 92% greater risk of avoidable death
  • Patients at “C” hospitals on average face an 88% greater risk of avoidable death
  • Patients at “B” hospitals on average face a 35% greater risk of avoidable death

The report also found that if all hospitals had an avoidable death rate equivalent to “A” hospitals, 50,000 lives would have been saved, versus 33,000 lives that would have been saved by “A” level performance in 2016.

Even “A” hospitals are not perfectly safe, but researchers found they are getting safer.

“The good news is that tens of thousands of lives have been saved because of progress on patient safety. The bad news is that there’s still a lot of needless death and harm in American hospitals,” said Leah Binder, president and CEO of the Leapfrog Group, in a press release. “Hospitals don’t all have the same track record, so it really matters which hospital people choose, which is the purpose of our Hospital Safety Grade.”

Some of the other notable findings in the spring 2019 grades include the following:

  • Of more than 2,600 hospitals graded, 32% earned an “A,” 26% earned a “B,” 36% earned a “C,” 6% received a “D,” and just under 1% got an “F”
  • The top five states with the highest percentages of “A” hospitals are Oregon (58%), Virginia (53%), Maine (50%), Massachusetts (48%), and Utah (48%)
  • There are no “A” hospitals in Wyoming, Alaska, Washington, D.C., Delaware, or North Dakota
  • Some 41 hospitals nationwide have achieved an “A” in every grading update since the launch of the Safety Grade in spring 2012

Overall, an estimated 160,000 lives are lost annually from the avoidable medical errors that are accounted for in the Leapfrog Hospital Safety Grade—a significant improvement from 2016, when researchers estimated 205,000 avoidable deaths.

Entire states, such as Oregon and Maine, tout their healthcare prowess with their report card results as proof. Other states, including Minnesota, have had to get real about their healthcare thanks to their poorer scores and have taken great steps to improve their facilities’ performance.

The grading system has led to some impressive improvements among hospitals in some states. In November 2018, six of Piedmont Healthcare’s 11 hospitals in Georgia received “A” grades in Leapfrog’s fall 2018 Hospital Safety Grade, twice as many as any other system in Georgia.

The independent, nonprofit grading system assigns “A,” “B,” “C,” “D,” and “F” grades to general acute care hospitals in the United States. Administered on behalf of employers and other purchasers, the Safety Grade is the nation’s only rating system focused entirely on errors, accidents, injuries, and infections. It is reviewed by a National Expert Panel and receives guidance from the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine. The Leapfrog Hospital Safety Grade is peer reviewed, fully transparent, and free to the public. It is updated every six months, once in the fall and once in the spring.

The Leapfrog Group was formed about 15 years ago from a group of America’s largest employers such as General Motors, Boeing, and Federal Express. The intent was to give their employees an even basis for nationwide comparison of physicians using an expert advisory panel of medical consultants. Over 10 years, the organization morphed into an independent, nonprofit consumer advocacy group monitoring patient safety. In June 2012, the group launched its first Hospital Safety Score.

Starting with information taken from a hospital-submitted self-survey, information is gathered from sources such as the Agency for Healthcare Research and Quality (AHRQ), the CDC, and CMS. In addition, 26 other measures are taken into consideration, including hand hygiene, antibiotic usage, rates of death among surgical patients, ICU physician staffing, infection control, and methods that physicians use for ordering medicines and procedures.

Healthgrades announce awards

Also in May, Healthgrades, a Denver-based online resource for information about physicians and hospitals, announced recipients of the annual Healthgrades 2019 Patient Safety Excellence and Outstanding Patient Experience Awards.

The awards were announced in time for the American Hospital Association’s National Hospital Week, which took place May 12–18. While not a report card grade, the awards, which have been given out since at least 2010, recognize the hospitals around the country that make patient safety a top priority and provide an outstanding patient experience.

Healthgrades recognized 460 hospitals across the nation, placing them among the top 10% of all short-term acute care hospitals reporting patient safety data, according to a release from Healthgrades.

During the study period from 2015 to 2017, these hospitals demonstrated excellent performance in safety provided for patients in the Medicare population, as measured by objective outcomes for 14 Patient Safety Indicators defined by the AHRQ. On average, the group estimates that some 127,667 patient safety events could have been avoided if all hospitals performed similarly to award recipients on each of the 14 indicators.

The awards are difficult to achieve; as part of the assessment, Healthgrades has what it calls a “Retained Foreign Object” indicator. Basically, it’s considered a “never” event, and hospitals that report even one of these events are ineligible for the award.

Healthgrades found that during the study period, patients treated in hospitals receiving the award experienced the following positive outcomes compared to other hospitals that did not receive awards. Specifically, awarded hospitals were:

  • 56% less likely to experience an accidental cut, puncture, perforation or hemorrhage during medical care
  • 51% less likely to experience a collapsed lung due to a procedure or surgery in or around the chest
  • 64% less likely to experience hospital-acquired pressure sores or bedsores
  • 57% less likely to experience catheter-related bloodstream infections acquired at the hospital

“Consumers are becoming more involved in their own health care and are spending more time researching and selecting the right provider and hospital for their specific needs,” said Brad Bowman, MD, chief medical officer of Healthgrades, in a written statement. “Healthgrades’ Patient Safety Excellence Award & Outstanding Patient Experience Award highlights the hospitals that are making patient safety and experience a priority and will help patients feel confident to make more informed decisions about their health care.”

By comparison, in 2018 some 458 hospitals across the nation achieved the award. During the 2014–2016 study period, hospitals that received an award compared as follows to hospitals that did not get awarded:

  • 56% less likely to experience an accidental cut, puncture, perforation or hemorrhage during medical care
  • 52% less likely to experience a collapsed lung due to a procedure or surgery in or around the chest
  • 63% less likely to experience catheter-related bloodstream infections acquired at the hospital
  • 54% less likely to experience hospital-acquired pressure sores or bedsores

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at johnpalmer@palmereditorial.com.