Hospitals are getting report cards.
A new "Hospital Safety Score" issued by The Leapfrog Group, a non-profit employer-sponsored organization enables anyone with internet access to check out which hospitals are the least, and which ones the most, likely to cause avoidable patient harm.
Leapfrog reviewed 2,651 facilities across the country and generated a report card for each, with an A, B, C, D or F letter grade.
For example, 729 hospitals got an A, 679 a B, 1,111 earned a C, and 132 have a "Grade Pending," indicating that they really got a D or an F. But Leapfrog is giving these hospitals a chance to improve and will issue final grades in November. Grading was not applied to critical access hospitals. Neither was it applied to hospitals in the state of Maryland because they do not report data to the Centers for Medicare & Medicaid Services. And it was not applied to hospitals in Guam and Puerto Rico or any other hospital that did not have at least 14 measures to evaluate.
The scores, which may be viewed at hospitalsafetyscore.org, include a list of 26 weighted measures, such as the number of patients who develop severe pressure ulcers, have surgical objects left inside their body cavities, or develop postoperative pulmonary emboli. They also take into consideration the frequency with which the hospital employs best practices to prevent pneumonia, infections, or other complications.
"Most of us know lots of people who have suffered from injuries and infections in hospital settings," says Leah Binder, Leapfrog Group CEO. "In fact, anyone who goes to the hospital almost invariably has some story of unnecessary suffering and harm, so it is rampant—a major problem."
Unfortunately, Binder says, until now, only certain healthcare insiders knew how to interpret the "the plethora of data about patient safety, and no one else. So we brought together the top experts in patient safety around the country to put together one score that any consumer can understand before they walk into the door of a hospital, a score that will tell them how safe it is."
"People deserve to know that some hospitals are safer than others," she says.
The American Hospital Association is not happy with the new scorecard. In a terse one-sentence statement, Nancy Foster, the AHA's Vice President of Quality and Patient Safety Policy said: "The American Hospital Association has supported several good quality measures but many of the measures Leapfrog uses to grade hospitals are flawed and they do not accurately portray a picture of the safety efforts made by hospitals."
Ashish Jha, MD, of the Harvard School of Public Health Department of Health Policy and Management, and one of nine members on Leapfrog's advisory panel that determined which components would be used, explained the rating system.
"This is a patient safety score. It's not the same as whether you'll have a good experience in the hospital, and not even whether you'll get high quality care, such as the right tests or the right medications. This is about whether you will be harmed if you go to this hospital, and that's a very specific thing," Jha says.
The Leapfrog score is very different than the quality scores now available on Medicare's Hospital Compare, in which one or two percent of hospitals score "better than" or "worse than" in a category, like rates of 30-day readmissions or 30-day mortality, and 96% to 98% are all "average."
On the contrary, Binder says. Large numbers of hospitals are in each of the A, B and C grades.
She says that there were a considerable number of "surprises" in how the hospitals scored.
For example, some hospitals with excellent reputations scored poorly. Among the surprises, Baldridge Award winner Henry Ford's main campus in Detroit and the Cleveland Clinic's main campus and most of its hospitals (except for its Florida location) scored Cs, she says.
On the other hand, she says, "some hospitals that serve some of the most challenged populations in the U.S. earn As, such as Bellevue and Montefiore in New York City and Detroit Receiving" Hospital in Detroit.
"Though some hospitals surprised us, a good many did not, with highly regarded hospitals earning a safety score consistent with their larger reputation: like Mayo, Virginia Mason, Brigham and Women’s, and NYU—all (received) As," Binder says.
On the lower end of the rating system, hospitals that received a "grade pending," indicating a D or F, include University of California Ronald Reagan UCLA Medical Center in Los Angeles; Jackson Memorial Hospital, Jackson North Medical Center and Jackson South Community Hospital in the Miami area; Inova Fairfax Hospital in Falls Church, VA; Grady Memorial Hospital in Atlanta; St. Joseph's Hospital in Philadelphia; and Scott & White Memorial Hospital in Temple, TX.
Jha says his analysis of the scorecard reveals that hospital scores are distributed throughout the grades relatively evenly, so it isn't like hospitals that take care of the sickest patients get the poorer grades. Nor is there any pattern seen based on the hospital's size, region of the country, for profit, public or private, non-profit ownership, or whether it is an academic teaching hospital.
However, hospitals that got Cs were somewhat more likely to have a medical intensive care unit, less likely to be a member of a hospital system, and more likely to be a hospital receiving disproportionate share funds than hospitals receiving a grade of A or B. Grade A hospitals had a slightly better nurse-to-patient ratio than those hospitals that received Bs or Cs.
Binder explains that the letter grades were designed around the initiative that began years ago in Los Angeles "where the public health departments inspect restaurants and give them a grade, and the restaurants are required to post that grade in their windows."
Studies indicate that more than 60% of customers consult a restaurant's grade before eating there, Binder says "And If people look at a grade as a safety indicator before going to eat in a restaurant, wouldn't they also look at a grade as a safety indicator before going to a hospital, which is clearly more important?"
Several patient safety experts across the country say that such a score is sorely needed to help patients make decisions, especially where to go if they need to have surgery.
"I would hesitate before going to a C hospital if there was an A hospital that was equally convenient and I had equal confidence in the doctor," says Robert Wachter, MD, another member of the Leapfrog advisory panel and a national patient safety expert at the University of California San Francisco.
Wachter notes that though 12 years have passed since the Institute of Medicine's groundbreaking report, "To Err Is Human," highlighted the shockingly high numbers of deaths and unintended consequences due to hospital errors, "it's still difficult for a patient, a family member or a clinician to determine if a hospital is truly safe."
One reason he thinks Leapfrog's report card will help, he says, is that when Hospital Compare was first published, it revealed a level of transparency that prompted providers, including his colleagues at UCSF, to make "substantial changes in resource allocation and what we paid attention to, even though it was not really an issue of consumerism. Even though no one had the sense that a lot of patients were going to it to make decisions on where to get care based on that."
Much more important, Wachter says, is that transparency like this "increases the probability that all hospitals will improve. Hospitals will work to understand the data, and figure out how they can all make healthcare safer."
Of the 26 measures, 13 involved outcomes of care, for example the number of times patients:
- Had a retained surgical object
- Developed an air embolism stage
- Developed a stage three or four pressure ulcer
- Developed a central line bloodstream infection
- Developed a stage three or four three or stage four pressure
- Died after surgery while in the hospital
- Developed an avoidable collapsed lung.
- Suffered a postoperative respiratory failure
- Suffered a postoperative pulmonary embolism or deep vein thrombosis,
- Received an accidental puncture or laceration
- Experienced a surgical suture come apart
Other elements making up the scores include process measures that are likely to lead to safer care. These include whether the hospital uses higher levels of intensive care unit physician staffing, and computerized physician order entry systems, medication reconciliation practices, evaluation of catheter necessity and removal, and observed levels of handwashing compliance.
Leapfrog used data it received from hospitals' voluntary reports and available Medicare data.
Other members of the patient safety panel that developed the scoring system for Leapfrog include Lucian Leape, MD, of Harvard; Arnold Milstein, MD, of Stanford; John Birkmeyer, MD, of the University of Michigan; Peter Pronovost, MD, of Johns Hopkins University; Patrick Romano, MD of the University of California at Davis; Sara Singer of Harvard; and Tim Vogus of Vanderbilt University.