Many Hospitals Still Falling Short in Reaching Patient Safety Goals
While more hospitals are making progress in incorporating measures to prevent medical errors, they still have a long way to go to better ensure patient safety using tested methods, according to a new report released yesterday by The Leapfrog Group, the nonprofit organization representing major private and public purchasers of healthcare benefits.
"I guess the big word is going to have to be 'disappointing,'" said Leapfrog CEO Leah Binder. The report, based on 2008 survey results received from 1,282 acute care hospitals nationwide, does show that "hospitals are making great strides and great efforts" to address patient safety concerns, she added.
However, most of the final numbers in Leapfrog's survey "are simply not adequate for the most expensive healthcare system in the world—in what should the best healthcare system in the world," Binder said. Failure to make these changes nationwide means higher mortality rates, higher volumes of care, and higher healthcare costs in the future—factors that could receive closer scrutiny during the healthcare reform debate.
For instance, Leapfrog found from the survey that only 7% of surveyed hospitals fully met its computerized physician order-entry standard (CPOE) standard. Under this measure, hospitals must enter at least 75% of their inpatient medication orders through their CPOE system. They must also assess implementation of the CPOE system with a Leapfrog evaluation tool that ensures the system is alerting prescribers of common medication errors.
The CPOE standard has been in place on the Leapfrog survey since 2002—when only 2% of hospitals met that standard, said Barbara Rudolph, director of Leapfrog's Leaps and Measures.
Research evidence has shown that use of CPOE systems could reduce adverse events by about 88%; if these systems were widely in place nationwide, over 3 million serious medication errors annually could be prevented, Rudolph added.
Also, ongoing research has also shown that nearly 3,000 deaths could be avoided annually if Leapfrog standards were used for eight high-risk procedures performed in hospitals, Rudolph said. "If hospitals were to meet our standards, they could reduce the risk of dying between two to four times."
The rate of reporting hospitals found to be fully meeting volume and risk adjusted mortality standards—or adhering to nationally endorsed process measures—for the high-risk procedures were:
- 43% for heart bypass surgery or coronary artery bypass graft
- 35% for heart angioplasty or percutaneous coronary intervention
- 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 other findings, the survey showed that only 31% of hospitals fully met the Leapfrog standard for staffing hospital intensive care units managed by board-certified intensivists. However, on a positive note, another 7% of hospitals said they do plan to add intensivists by the end of 2009.
"In the ICU, you can see a reduction of 40% mortality when there is appropriate staffing by trained intensivists," Rudolph said. "Overall, if this were implemented in all urban hospitals with ICUs, we could avoid 54,000 deaths annually, and avoid spending $4.3 billion on the extra care that results when there is not an intensivist in place."
As for hospital infections, 65% of hospitals do not have all of Leapfrog's recommended policies in place to prevent hospital-acquired infections. This rate, though, is an improvement over 2007 in which 87% of hospitals had no policies in place.
Compliance with Leapfrog's efficiency of care standards also was disappointing, Binder said. Under this standard, hospitals must demonstrate high quality care with low resource use. "The vast majority of hospitals couldn't improve their quality using fewer resources than what they do now."
For instance, only 24% met the efficiency standard for heart bypass surgery, 21% for heart angioplasty, 14% for heart attacks, and 14% for pneumonia. "We know . . . there are hospitals that were outstanding in this regard—that had both extremely positive outcomes and at the same time used the fewest resources of any kind," Binder said. "It is possible to do this, so we look forward to seeing great improvement of this in the future."
The Leapfrog Group 2008 Hospital Survey results, along with hospital comparisons, are available at www.leapfrog.org.