Hospitals are increasingly adopting technologies aimed at reducing medication and other errors, but they continue to struggle with variation in the quality of care provided to patients and in adoption of safe practices.
Those are a few of the highlights from a survey of more than 1,500 U.S. hospitals by the Leapfrog Group, a not-for-profit organization representing large employers, and health information technology vendor Castlight Health.
The analysis looked at performance in seven areas of hospital quality and safety: medication errors, maternity care, high-risk surgeries, hospital-acquired conditions, intensive-care unit staffing, serious adverse events and compliance with safe practices.
Hospitals continue to struggle with reducing rates of certain hospital-acquired conditions. One in 6 hospitals had higher central-line-associated blood stream infections rates than expected, and 1 in 10 performed poorly on preventing catheter-associated urinary tract infections.
In December the CMS identified 724 hospitals that will get hit with the first round of penalties imposed under the Hospital-Acquired Condition Reduction Program. The agency estimated that overall Medicare payments would drop by roughly $330 million in 2015 due to the HAC program.
This spring the agency proposed changes to the program that would increase the population of patients included in central-line-associated blood stream infection and catheter-associated urinary tract infection measures to include those in select, non-intensive-care unit sites within a hospital.
Although the Leapfrog survey format did not include feedback from the hospitals on the challenges of improving the infection rates, spokeswoman Erica Mobley said there are plenty of opportunities to learn from high performers.
There were also difficulties reported in instituting never-event policies, such as having procedures for offering harmed patients an apology, performing effective root-cause analyses and waiving costs when a never event occurs.
Only 1 in 5 hospitals had adopted such policies, which Mobley said was disappointing. “This is one measure where performance has remained stagnant for several years,” she said. “All hospitals should be able to commit to having such a policy in place.”
Those two issues were highlighted by other healthcare quality groups in recent weeks. The National Patient Safety Foundation issued recommendations in June meant to help hospitals revamp their approach to conducting root-cause investigations, and a study in the journal BMJ Quality and Safety said patients may be more likely to sue following an injury if a facility doesn't admit a mistake.
But the survey suggests hospitals are achieving success in other areas, including use of computerized physician-order-entry systems and in reducing rates of early elective deliveries.
More than 1,300 hospitals reported using computerized medication ordering systems in 2014, compared with only 384 in 2010. More than half of those entered at least three-quarters of inpatient medication orders using those computer systems and had effective medication-error alerting systems in place.
The national average for cesarean procedures, which are often done out of convenience rather than medical necessity, hit its lowest rate—3.4%—since the start of the annual survey in 2010.
The reports have focused on maternity care, high-risk procedures, computerized physician order entry, nursing, and hand hygiene.
