These are the Raleigh area’s most unsafe hospitals. See the report’s ratings

Even with North Carolina’s strong reputation for hospital safety, some facilities didn’t fare as well in the fall 2025 Hospital Safety Grades.

The Leapfrog Group, a national watchdog, reviewed 93 hospitals across the state, assigning each an A-F letter grade.

Here’s a look at which Triangle-area hospitals landed at the bottom and what those scores really mean.

What makes a hospital safe?

The Hospital Safety Grade list assigns a letter grade to general hospitals in the U.S. based on how well they prevent medical errors, accidents, injuries and infections that kill or harm patients.

About 30 measures are used to determine these safety grades. The Leapfrog Group also utilized these five patient experience measures that have a direct relationship with safety outcomes to come up with grades:

• Nurse communication
• Doctor communication
• Staff responsiveness
• Communication about medicines
• Discharge communication

Grades are assigned using publicly available data, and measures’ scores are calculated using patient responses to a national and standardized survey following a hospital visit, Leapfrog said.

In recent years, Leapfrog ranked North Carolina hospitals:

• No. 1 in spring 2022
• No. 7 in fall 2022
• No. 6 in spring 2023
• No. 3 in fall 2023
• No. 8 in spring 2024
• No. 4 in fall 2024
• No. 12 in spring 2025
• No. 5 in fall 2025

Leapfrog: Worst hospitals in the Triangle

Central Carolina Hospital in Sanford was the only hospital in the Triangle​ to earn a “C” grade. Here are some of the areas where the hospital could improve, according to Leapfrog:

• Prevalence of harmful events following a surgery, procedure or birth
• Patients developing dangerous bed sores
• Prevalence of patient falls and injuries, resulting in broken hips
• Prevalence of collapsed lungs, when air leaks out of the lung and goes into the area between the lungs and the chest wall
• Improve communication between patients and hospital staff, and about medicine to patients

How are hospital safety grades calculated?

Leapfrog’s Hospital Safety Grades are assigned biannually — once in the spring and once in the fall. The Hospital Safety Grade program was established in 2012.

▪ Grades are assigned using letters, with A as the best possible grade and F as the worst.

▪ The overall grades are based on about 30 evidence-based measures of the basics of patient safety, including handwashing, entering prescriptions through a computer and the availability of highly trained nurses.

▪ The grades are assigned using data from various public sources, including the Centers for Medicare and Medicaid Services.

▪ Grades are generally assigned to nearly 3,000 hospitals. Any general, acute-care hospital in the U.S. for which there is enough publicly available data is included in the grading list.

▪ Individual scores that contribute to a hospital’s overall letter grade fall into five categories:

• Infections, including how often patients at the hospital contract MRSA, urinary tract infections, blood infections and more.
• Problems with surgery, including how often dangerous items are left in a patient’s body after surgery, how often surgical wounds split open and accidental cuts and tears.
• Safety problems, including patient falls and dangerous bed sores.
• Practices to prevent errors, including handwashing and safe medication administration.
• Doctors, nurses and hospital staff, including having enough qualified nurses and performing patient bedside care.

Leapfrog: Best hospitals in the Triangle

The following Triangle-area hospitals received A grades in Leapfrog’s Fall 2025 Hospital Safety Grades report:

• Duke Regional Hospital (Durham)
• Johnston Health (Smithfield)
• Johnston Health (Clayton)
• Rex Hospital, Inc. (Raleigh)
• WakeMed Cary Hospital (Cary)
• WakeMed North Hospital (Raleigh)
• WakeMed Raleigh Campus (Raleigh)
• University of North Carolina Hospitals (Chapel Hill)

These received B grades:

• Duke Raleigh Hospital (Raleigh)
• Duke University Hospital (Durham)
• REX Holly Springs Hospital (Holly Springs)

How should you use Leapfrog’s hospital safety scores?

In a video explaining how to use the hospital safety grades, Leapfrog recommends using them to inform your decision when choosing a hospital or to learn more about hospitals in your area.

▪ Using Leapfrog’s search tool on the homepage at hospitalsafetygrade.org, you can search for hospitals by hospital name, city and state, just state, or by ZIP code.

▪ When you get to your results page, Leapfrog recommends looking for hospitals with the highest grade.

If there is more than one hospital with a good grade, consider other things that are important to you when seeking care, such as the hospital’s location and proximity to you.

If a hospital doesn’t have a good grade, Leapfrog recommends searching for another location or talking with your doctor about what you can do to stay safe in the hospital.

The overall letter grade for a hospital gives you the “big picture,” Leapfrog says. However, you can also see the individual scores that make up the hospital’s grade.

▪ If there are certain issues or risks you’re concerned about, make sure to check the hospital’s score on that measure. Leapfrog recommends always checking a hospital’s scores on handwashing, blood infections and patient falls.

▪ Each score the hospital receives is also listed with the best and worst score on that measure by any hospital and the average score for hospitals on that measure.

More information on how to use the Hospital Safety Grades can be found at hospitalsafetygrade.org/your-hospitals-safety-grade/how-to-use-the-grade.

How to stay safe during a hospital visit

Regardless of a hospital’s safety grade, Leapfrog recommends the following tips to stay safe if you need to receive care at a hospital:

▪ Bring someone with you when you arrive and when you’re discharged. If possible, also try to have someone visit every day of your stay.

The extra person can ensure that even when you’re groggy or tired, there’s someone there to be alert, ask questions, and advocate for your care. Hospitals might have patient advocates on staff who can also provide these resources.

▪ Be alert and say something. During your stay, you or your companion should take notes to keep track of what’s happening, including if hospital staff and your care team are washing their hands.

▪ Know your medications. Leapfrog recommends keeping track of which medications you’re taking during your stay and why you’re taking them.

Don’t be afraid to ask your care team for this information. You can also request that your care team cross-check your name with your medications before giving them to you to prevent possible mix-ups.

Kimberly Cataudella Tutuska’s reporting contributed to this story

Evan Moore

The Charlotte Observer

Evan Moore is a service journalism reporter for the Charlotte Observer. He grew up in Denver, North Carolina, where he previously worked as a reporter for the Denver Citizen, and is a UNC Charlotte graduate.