Two Triangle hospitals downgraded for safety lapses

The Leapfrog Hospital Safety Grade explained

The Leapfrog Group, a Washington-based nonprofit, put together this explainer on how they grade hospitals and what you can do. Two Triangle hospitals saw their grades drop from A to C when the latest ratings came out on Tuesday, April 24, 2018.
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The Leapfrog Group, a Washington-based nonprofit, put together this explainer on how they grade hospitals and what you can do. Two Triangle hospitals saw their grades drop from A to C when the latest ratings came out on Tuesday, April 24, 2018.

Triangle hospitals have ranked among the nation's safest health care facilities year after year, but your local hospital visit may not be as safe as previously assumed. The region got hit with surprisingly weaker safety grades in a biannual scoring report issued Tuesday by the Washington-based nonprofit Leapfrog Group.

Two hospitals — WakeMed Cary and Duke University Hospital — unexpectedly dropped from top A grades to C's in Leapfrog's Spring 2018 safety ranking for errors, accidents and infections. Until this round of safety rankings, Duke University's research and teaching hospital in Durham had delivered straight A's for the past three years, whereas WakeMed Cary had been awarded A's, and one B, since last getting a C in the spring of 2015.

The Triangle's A-rated hospitals are: UNC Rex in Raleigh, UNC Hospitals in Chapel Hill, Johnston Health in Smithfield, Duke Regional in Durham and Duke Raleigh Hospital. The B grade went to WakeMed Health & Hospitals flagship facility in Raleigh.

The Leapfrog Group, a Washington-based nonprofit, put together this explainer on how they grade hospitals and what you can do. Two Triangle hospitals saw their grades drop from A to C when the latest ratings came out on Tuesday, April 24, 2018.

The Leapfrog Safety Grade assesses about 2,500 acute care hospitals nationwide, based on 27 performance measures, producing a composite letter grade. The group assessed 74 hospitals In North Carolina, giving 42 percent of them an A, and ranking the state 9th in the nation for percentage of A-rated hospitals.

The safety score is derived from data compiled by the Centers for Medicare & Medicaid Services, Agency for Healthcare Research Quality, Centers for Disease Control and Prevention, American Hospital Association, Health Information Technology Supplement and Leapfrog's own survey.

Leapfrog advises the public never to reject emergency treatment based on a safety score, but to consult with a doctor about the best hospital for planned, elective procedures. The organization said hospital errors, injuries, accidents and infections cause up to 440,000 patient deaths a year, and noted that one in 25 patients develops a preventable infection during a hospital stay.

"We know 'A' hospitals do a better job at preventing errors," Leapfrog said in a statement. "We hope all hospitals will strive to offer this level of dependable care."

Duke University President Thomas Owens, who is also the senior vice president of the Duke University Health System, affirmed the value of Leapfrog's ratings and vowed to improve the hospital's safety score. Owens, who also sits in Leapfrog's hospital advisory committee, the data for falls in the Leapfrog report is three years old and doesn't reflect Duke's safety today.

"While we are disappointed with a 'C' in this particular six-month Leapfrog rating period, we understand the factors that drove this particular grade and believe that significant ongoing quality improvements will result in our return to an 'A' grade that we have earned for the past many rating periods," Owens said in an emailed statement. "We value the quality and safety analyses provided by Leapfrog, as well as those performed in many other publicly reported surveys that continue to rate Duke University Hospital as one of the top hospitals in the country.”

According to Leapfrog, Duke University Hospital had more hospital-acquired infections, surgical complications, bed sores and patient falls than the average hospital across the country. Duke was also below average in "Effective leadership to prevent errors."

WakeMed's chief quality and medical staff officer, West Paul, said WakeMed expected to be downgraded this time because the Cary hospital experienced an increase in intestinal bacteria infections, particularly among older patients from area nursing homes. Paul said WakeMed Cary is allowed 25 infections in a year but reported 37 for the period assessed by Leapfrog, up from 24 in the previous reporting period. That resulted in an infection rate that's twice as high as the national average, according to Leapfrog.

WakeMed Cary's Leapfrog score noted that the hospital is below the national average in 4 out of 5 categories of infections , with below average scores insurgical complications, bed sores and patient falls. But Leapfrog gave WakeMed high marks for staff performance including hand washing, effective leadership to prevent errors and having specially trained doctors care for ICU patients.

Leapfrog's director of operations, Erica Modley, said a hospital's safety score can decline for two general reasons: it underperforms or its performance holds steady but other hospitals in the country improve, which would cause it to rank lower on a national average.

Leapfrog advises that when reviewing hospital safety, patients should start by reviewing three measures: hand washing practices, blood infections and patient falls. Those three measures don't necessarily predict a hospital's overall safety grade, however. In the Triangle, some A hospitals are below the national average in the three key areas, while some C hospitals outperform the nation's hospitals.

For example, every Triangle hospital received a top score for hand washing, including the two hospitals with overall C safety grades. Johnston Health, an A-rated hospital, was not graded in hand washing because it declined to report data in this category.

About half of the Triangle's hospitals were better at preventing patient falls than a typical hospital, with A-ranked UNC Hospitals landing in the middle. Those that did worse than the national average were B-ranked WakeMed Raleigh, C-ranked Duke University Hospital and A-ranked Duke Regional.

Triangle hospitals with below-average performance for blood infections were B-ranked WakeMed Raleigh, C-ranked WakeMed Cary, C-ranked Duke University Hospital, A-ranked UNC Hospitals and A-ranked Duke Raleigh.

UNC Rex is the only Triangle hospital — and one of only 49 in the country — to receive an A grade every six months since the Leapfrog Safety Grade was launched in 2012.

But Leapfrog assesses many other areas of hospital performance. There are five categories of hospital infection, including bacterial, urinary and surgical site infections. Leapfrog tracks seven surgical complications, including collapsed lung, blood clot, dangerous object left in patient's body, and patient death. In addition to patient falls, other safety problems tracked include bed sores and air bubbles in the bloodstream. Leapfrog also assess training, staffing and hospital protocols.

Not all hospitals make the Leapfrog list. Those with incomplete information are excluded. Many don't submit information because they're too small or lack data, such as specialty hospitals, and military and veteran's hospitals.

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