The Leapfrog Hospital Safety Grade explained
Hospitals in the Triangle rank among the nation’s best for patient safety, according to the fall 2018 survey issued Thursday by the Washington-based nonprofit Leapfrog Group.
The Leapfrog Safety Grade assessed 79 hospitals in North Carolina among more than 2,600 acute care hospitals nationwide, issuing a composite letter grade based on 28 performance measures for errors, accidents, injuries and infections. Nearly three-fourths scored an A or a B, which was better than the national average. Across the country slightly more than half received an A or a B.
Overall, 43 percent of North Carolina hospitals got an A, 28 percent got a B, and 29 percent got a C. No hospitals in the state got a D or an F.
All Triangle hospitals but one received an A, and some did worse than the national average in certain key safety measures.
Leapfrog says that as many as 440,000 people die every year from hospital errors, injuries, accidents and infections, and a Medicare patient has a 25 percent chance of being harmed, injured or dying in a hospital.
Because the 28 safety categories can seem overwhelming, Leapfrog advises patients to start by reviewing just three measures: hand washing practices, blood infections and patient falls. Even a hospital with an overall A grade can be worse than the national average in one or more of these key safety metrics.
Leapfrog letter grades for the same hospital can vary from one rating period to the next, and the scores may not reflect a hospital’s current performance level. Most of the information used to grade hospitals in the fall 2018 Leapfrog Hospital Safety Grade is from 2017 and 2018. But some data on hospital-acquired conditions patient safety indicators cover incidents between 2015 and 2017.
What’s more, because the letter grade is relative to other hospitals, a particular hospital’s safety score can slip even if that hospital’s performance stays the same, just because other hospitals improved.
The only local hospital to get a C in the fall 2018 rating period was WakeMed Cary Hospital. WakeMed Cary also got a C in the spring 2018 ratings, but in 2017 the hospital received two A grades from Leapfrog. WakeMed Cary was worse than the national average in blood infection rates, one of the key measures recommended by Leapfrog.
West Paul, WakeMed’s senior vice president & Chief Quality & Medical Staff Officer, said in an emailed statement that the organization has programs in place to reduce hospital infections, and noted that WakeMed Cary narrowly missed a B grade.
“Chasing Zero is a patient safety initiative aimed at achieving zero instances of preventable patient harm within our facilities,” WakeMed’s statement said. “WakeMed Raleigh Campus received an A grade, thanks in part to small but continual reductions in infection rates and improvement in numerous patient safety measures.”
Duke University Hospital in Durham, frequently ranking among the nation’s elite teaching hospitals, got an A in the fall 2018 ranking. Still, Duke University Hospital, which handles more complicated cases than a community hospital, was worse than the national average in blood infections and in patient falls and trauma for the past two years.
In the spring, the hospital received a C, and at the time, Thomas Owens, president of Duke University and the senior vice president of the Duke University Health System, told The News & Observer the data in the report was three years old and didn’t reflect Duke’s safety today. Owens also vowed to improve the hospital’s score.
Other Triangle hospitals that got As in the fall ranking are: UNC Hospitals in Chapel Hill, UNC Rex in Raleigh, WakeMed Raleigh, Duke Raleigh and Duke Regional in Durham.
The safety score comes 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 scores evolve over time as new information becomes available. For the fall 2018 rating, Leapfrog scored hospitals for their use of the Bar Code Medication Administration, which is designed to reduce the risk of giving patients the wrong drugs. Leapfrog said medication errors are the most common errors made in hospitals, but no Triangle hospital submitted this data this time around and it’s not included in their letter grades.
Leapfrog assesses many multiple areas of hospital performance: five categories of hospital infection, including bacterial, urinary and surgical site infections; seven surgical complications, including collapsed lung, blood clot, dangerous object left in patient’s body and patient death. Other safety problems tracked include bed sores and air bubbles in the bloodstream. And Leapfrog also assesses training, staffing and hospital protocols.
Leapfrog says its safety score should never be the sole reason for selecting a hospital, and the group advises people to take the score into consideration when choosing a hospital for planned, elective procedures. The organization says patients should never to reject emergency treatment based on a Leapfrog safety score.