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Most hospitals not meeting safety goals, Leapfrog says
Most hospitals still have not implemented standards proven to improve quality and save lives, even though it has been 10 years since the Institute of Medicine's (IOM) landmark report on the failure of U.S. hospitals to adequately protect patient safety. That is the conclusion of the 2008 Leapfrog Hospital Survey, which shows that only 7% of hospitals fully meet Leapfrog medication error prevention standards, and low percentages of hospitals are fully meeting mortality standards.
Leah Binder, MA, MGA, CEO of the patient safety organization, based in Washington, DC, says the survey results are disappointing.
"As the Obama administration and Congress consider health care reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation's $2.3 trillion annual investment," she says. "According to our data, a majority of hospitals have significant safety and efficiency deficits."
Health care reform will seek to make the system more cost-effective, Binder notes, but the survey results do not bode well.
"Among surveyed hospitals, efficiency standards - defined as highest quality and lowest resource use -are met by only 24% of hospitals for heart bypass surgery, 21% for heart angioplasty, 14% for heart attack care, and 14% for pneumonia care," she reports.
Barbara Rudolph, PhD, MSSW, director of Leaps and Measures for Leapfrog, says results were not good for one of key Leapfrog standards - the implementation of computerized physician order entry (CPOE) to decrease medication errors.
"CPOE has been in place in our survey since 2002; and at this time, only 7% of our hospitals fully meet this medication error prevention standard," she says. "CPOE systems like this can actually reduce adverse events by about 88%, and if these systems were widely in place, we could prevent over 3 million serious medication errors a year."
In 2002, only 2% of the surveyed hospitals met the CPOE standard.
The voluntary Leapfrog Hospital Survey results include 1,276 hospitals in 37 major U.S. metropolitan areas, representing 53% of hospital beds in these areas. Binder says the 2008 hospital survey reveals relatively low percentages of reporting hospitals are fully meeting volume and risk-adjusted mortality standards, or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives. She cites these data showing compliance with standards:
43% for heart bypass surgery;
35% for heart angioplasty;
32% for high-risk deliveries;
23% for pancreatic resection;
16% for bariatric surgery;
15% for esophagectomy
7% for aortic valve replacement;
5% for aortic abdominal aneurysm repair.
In addition, the report cites these other results:
Sixty-five percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs).
Seventy-five percent do not fully meet the standards for 13 evidence-based safety practices, ranging from hand washing to competency of the nursing staff.
Only 26% and 34% of reporting hospitals are fully meeting standards for treating two common acute conditions, heart attacks and pneumonia, respectively.
Only 30% and 25% of hospitals are fully meeting standards to prevent hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.
Binder and Rudolph says the report clearly indicates that, despite an initial surge of interest and calls to action, health care providers are not responding quickly enough to the IOM report.
"Progress on patient safety is moving too slowly," Binder says. "Consumers and purchasers of health care want hospitals to implement safety standards and procedures known to improve quality and reduce unnecessary injury and death. The safety goals Leapfrog promotes are achievable. More hospitals should be meeting the Leapfrog standards for common and high-risk procedures."
Binder notes that, though the results could be more encouraging, the Leapfrog survey helps explain why some aspects of health care quality are lower in the United States than might be expected when considering how much is spent per capita on medical care in comparison to other countries.
"There is a lot of concealed information in the health care world," Binder says. "It is only when you have something like Leapfrog with providers willing to share this information and purchasers willing to pressure them to do so that we're able to get a really good picture of the country showing where we are in terms of health care," Binder says. "We know in the macro statistics that something is wrong in American health care. It's only when we're able to go hospital by hospital and look at these results, looking at them in a transparent way, are we able to see where the problems lie."
Binder also points out that the surveyed hospitals are among the best in the country, which makes some of the results even more of a concern.
"So, it's disturbing but it also gives us something to work with," she says. "Now we know where the problem is and we have something we can work on."
The news was not entirely bad, however. The report includes these noteworthy improvements by surveyed hospitals in 2008:
Thirty-one percent of hospitals now meet the Leapfrog ICU staffing standard, up from just 10% in 2002.
Hospitals with all of Leapfrog's recommended policies in place to prevent common HAIs jumped from just 13% to 35% between 2007 and 2008.
Sixty percent of hospitals have agreed to implement Leapfrog's "Never Events" policy when a serious reportable event occurs within their facility.
"The Never Events policy requires a number of measures in response to a never event, including not charging patients and their families for the expenses related to that event. We're seeing improvement in this area as well," Rudolph says. "Back in 2007, only 53% of hospitals agreed to the Never Events policy."
The full survey results and detailed information about the standards promoted by the Leapfrog Group are available online at www.leapfroggroup.org.