results of the 2013 leapfrog hospital survey

Results of the 2013 Leapfrog

Hospital SurveyDeveloped for The Leapfrog Group by Castlight Heath

www.LeapfrogGroup.org/HospitalSurveyReport

Rate of hospital participation in the 2013 Leapfrog Hospital Survey by stateResponses submitted as of December 31, 2013

SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

The Leapfrog standard for CPOE is aimed at ensuring that patients are being prescribed medications through a computerized order entry system that alerts prescribers to drug-drug interactions, drug-allergy interactions, and other potential prescribing errors

2009 2010 2011 2012 2013

10%

14%

18%

31%

43%

Hospitals Meeting Leapfrog's Computerized Physician Order Entry (CPOE) Standard

Year

Nati

onal

Per

cent

age

of H

ospi

tals


The Leapfrog standard for CPOE is aimed at ensuring that patients are being prescribed medications through a computerized order entry system that alerts prescribers to drug-drug interactions, drug-allergy interactions, and other potential prescribing errors


2008-2010 2011 2012 2013

52%

37% 36% 36%33%

13% 14%13%

CPOE Test Orders That Did Not Receive an Appropriate Warning

% of all tested orders that did not prompt appropriate warnings from hospital CPOE systems% of the tested orders that would have caused patient death, that did not prompt appropriate response from hosptial CPOE systems

Year

Perc

enta

ge o

f Ord

ers

Early elective deliveries are scheduled cesarean sections or medical inductions performed prior to 39 completed weeks of gestation without medical necessity, which carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of early elective deliveries before 39 weeks is less than or equal to 5%.

2010 2011 2012 2013

17%

14%

11%

5%

Average Rate of Early Elective Deliveries as reported to the Leapfrog Hospital Survey

Year

Rate

of E

arly

Ele

ctive

Del

iver

ies



2010 2011 2012 2013

30%

39%

46%

71%

% Hospitals Achieving ≤5% Early Elective Deliveries as reported to the Leapfrog Hospital Survey

Year

% H

ospi

tals

with

<5%

EED




MA MN ME SC WA CA NY LA AZ MI OR FL NJ PA NC CO IL VA TN GA MS TX WI NV IN WY OH UT0%

5%

10%

15%

20%

25%

30%

35%

Early Elective Deliveries as reported to the Leapfrog Hospital Survey, 2010 to 20132010 2013

State

Elec

tive

Deliv

ery

Rate

Leapfrog standard

An episiotomy is an incision made in the perineum (the birth canal) during childbirth. Although an episiotomy was once routine in childbirth, medical guidelines today recommend episiotomy only in a narrow set of cases. Leapfrog’s standard is that the hospital’s rate of episiotomy is less than or equal to 12%


0-5% 5.1-12% 12.1-20% 20.1-30% 30.1-40% >40%

257

348

226

114

3818

2013 Episiotomy Rate as reported to the Leapfrog Hospital Survey

Episiotomy Rate

Num

ber o

f Hos

pita

ls

Leapfrog standard

Leapfrog’s standard for High-Risk Deliveries is that the hospital delivers at least 50 very-low birth weight babies per year and ensures that at least 80% of mothers receive antenatal steroids prior to delivery OR the hospital has a lower than average morbidity/mortality rate for very-low birth weight babies.


2011 2012 2013

134 128108

224249

343

Number of Hospitals Meeting Leapfrog’s Standard for High-Risk Deliveries

Meets Standard Does Not Meet Standard

Year

Num

ber M

eetin

g St

anda

rd

Leapfrog predicts survival rates for high-risk procedures using two pieces of information: the number of patients who had the surgery at a particular hospital and the number of patients who died from having the procedure at that hospital. The survival rate predictors were developed by Drs. John Birkmeyer and Justin Dimick


0% 9.3% 20.9%

Aortic Valve Replacement

Abdominal Aortic Aneurism

Pancreatectomy

Esophagectomy

3.1% 4.8% 7.4%

0.9% 3.1% 6.9%

2.5% 9.4% 12%

Lowest Predicted Death Rate Average Predicted Death Rate Highest Predicted Death Rate

2013 High-Risk Procedure Predicted Mortality Rates as reported to the Leapfrog Hospital Survey

Hospital-acquired pressure ulcers at stage III and IV are “bedsores” that are caused by remaining in one position for a long time and can be prevented through known precautions. Stage III and IV pressure ulcers are very deep, serious sores that may reach muscle or bone. Leapfrog’s standard is that the rate of stage III and IV pressure ulcers is zero.


0 0.1-1 1.1-2 2.1+

692

597

15 3

2013 Stage III & IV Hospital-Acquired Pressure Ulcer Rates

Pressure Ulcers Per 1000 Inpatient Discharges

Num

ber o

f Hos

pita

ls

Hospital-acquired injuries are falls and other traumatic injuries (broken or dislocated bones, crushing injuries, or burns) that occur while a patient is in the hospital. Although some falls and injuries may occur when hospitals are providing quality care, many others can be avoided. Leapfrog’s standard is that a hospital’s rate of falls & injuries is close to zero


0 0.1-1 1.1-2 2.1-5 5.1+

232

939

96 34 6

2013 Hospital-Acquired Injury Rates

Injuries Per 1000 Inpatient Discharges

Num

ber o

f Hos

pita

ls

Leapfrog uses a standardized infection ratio (SIR) to aggregate a hospital’s performance on Central-Line Associated Bloodstream Infections across multiple ICU types and to standardize the reporting out of a hospital’s performance. The SIR is a ratio of a hospital’s actual number of infections over an expected number of infections.

0 0.1-1 1.1-2 2+

15.0%

64.4%

16.8%

3.7%

18.1%

67.9%

11.8%

2.2%

18.8%

65.8%

13.5%

1.9%

Standardized Infection Ratios for Central Line- Associated Blood Stream Infections as reported to the Leapfrog Hospital Survey

2011 2012 2013

Standardized Infection Ratio (lower is better)

% O

f Hos

pita

ls


Leapfrog uses a standardized infection ratio (SIR) to aggregate a hospital’s performance on Catheter-Associated Urinary Tract Infections across multiple ICU types and to standardize the reporting out of a hospital’s performance. The SIR is a ratio of a hospital’s actual number of infections over an expected number of infections. 2013 was the first year that Leapfrog included this measure on the survey.


0 0.1-1 1.1-2 2+

17.4%

71.8%

10.2%

0.6%

2013 Standardized Infection Ratios for Catheter-Associated Urinary Tract Infections as reported to the Leapfrog Hospital

Survey

Standardized Infection Ratio (lower is better)

% O

f Hos

pita

ls

Hospital-acquired Conditions (HACs) are medical conditions or complications that were not present when a patient was admitted to the hospital, but developed as a result of errors or accidents in the hospital. Hospitals can prevent many of these conditions; some hospitals have zero or close to zero reported HACs.


0 1 2 3 4

454

342

145

2813

Overall hospital performance on hospital-acquired conditions on the Leapfrog Hospital Survey, 2013

Number of hospital-acquired condition categories (CLABSI, CAUTI, Hospital-acquired pressure ulcers, Hospital-acquired injuries) with zero incidents

Num

ber o

f hos

pita

ls

Research has shown that hospitals staffing their ICUs with physicians who are certified in critical care medicine (intensivists) can reduce ICU mortality by as much as 40%. Leapfrog’s standard asks that patients in adult or pediatric medical and/or surgical or neuro ICUs are being cared for by intensivists. These intensivists are present at least 8 hours a day, 7 days per week. When not present in the ICU, the intensivist responds to pages within 5 minutes or has another physician, physician assistant, nurse practitioner, or trained nurse that does reach the patient within 5 minutes.

2011 2012 2013

35.1%

39.0%

41.7%

Percent of Hospitals Meeting Leapfrog’s ICU Physician Staffing Standard

Year

% H

ospi

tals

Mee

ting

Stan

dard


Leapfrog’s standard asks that the hospital has a policy in place so that if a Never Event occurs, the hospital will (a) apologize to the patient and/or family (b) report the event to an outside agency (c) perform root-cause analysis (d) waive costs directly related to the Never Event and (e) make a copy of the policy available to patients and payers


2009 2010 2011 2012 2013

831857

864

941

1119

387 343

283 244292

Number of Hospitals Meeting Leapfrog’s Never Events Policy Standard

Meets Standard Does Not Meet Standard

Year

Num

ber o

f Hos

pita

ls

Leapfrog asks hospitals to report on their implementation of eight National Quality Forum-endorsed Safe Practices that, if adopted, can improve patient safety in healthcare settings.


Leaders

hip Stru

ctures

Culture

Measurem

ent

Training i

n Team

work

Risk Id

entificati

on

Nursing W

orkforce

Medica

tion Mgm

t

Hand Hygi

ene

Ventilat

ors

45%

70%

56%59%

52%

59%

69%

62%

% of Hospitals With Perfect Compliance with Leapfrog Safe Practices by Practice, 2013

% H

ospi

tals

With

Per

fect

Com

plia

nce

Not having enough nurses and the lack of quality nurse education can expose patients to greater risk. Short staffing in particular has been linked to increased mortality, complications, adverse events, longer hospital stays, and greater resource usage. Leapfrog believes the public deserves to know about hospitals with strong nursing workforces, as this leads directly to increased safety and quality.


Awareness Accountability Ability Action

68.2%

82.2% 79.9%

51.0%

Nursing Workforce Best Practices Requirements Met on the 2013 Leapfrog Hospital Survey

Met all requirements

Area of Hospital Safety

Num

ber o

f Hos

pita

ls

Leapfrog is the only ratings provider that tracks and rewards Magnet® Status, an elite designation for nursing excellence, and gives credit to hospitals with this designation as fully meeting Leapfrog’s standard. Developed by the American Nurses Credentialing Center (ANCC), Magnet is the leading source of successful nursing practices and strategies worldwide.


2011 2012 2013

163

181

221

Hospitals Reporting Magnet Status Designation to the Leapfrog Hos-pital Survey

Year

Num

er o

f Hos

pita

ls

Many healthcare-associated infections (HAIs) are caused by pathogens transmitted from one patient to another via the contaminated hands of healthcare workers. The CDC estimates that approximately 2 million patients annually acquire an HAI, and nearly 90,000 patients die as a result. Hand hygiene is one of the most important and effective means to stop the spread of pathogens in healthcare facilities.


2011 2012 201322

23

24

25

26

27

28

2727.5 27.6

23.924.2

25.5

Hand Hygiene Average Compliance on Leapfrog’s Safe PracticeUrban Rural

Year

Hand

Hyg

iene

Saf

e Pr

actic

e Sc

ore

(Max

30)

results of the 2013 leapfrog hospital survey

Documents

leapfrog hospital survey

leapfrog standard

leapfrog group

hospital participation

leapfroghospital survey

drugdrug interactions

leapfrogs standard

medical necessity