Why safety efforts fell short
“This is the first round of the hospital safety grades where we have data from hospital performance during the height of the pandemic,” Leapfrog Group President and CEO Leah Binder said. “We might have hoped that hospitals would become experts at preventing infections by dealing with an infectious disease outbreak like the pandemic. But the opposite is the case.”
Instead, focus on public health emergency provisions and pandemic-related safety and staffing issues likely distracted system leaders from taking the necessary precautions to prevent other kinds of hospital acquired infections, Binder said.
Dealing with sicker patients who had to be on ventilators longer and floating clinical staff to care areas with which they were unfamiliar introduced more potential infection risks that hospitals had to deal with, said Akin Demehin, senior director of quality and patient safety at the American Hospital Association.
"Hospitals had to constantly balance influxes and surges of COVID-19 patients while keeping the doors open for others who needed care," Demehin said. "The significant gains that hospitals had made in patient safety and in reducing infections prior to the pandemic were more challenging to sustain."
How hospitals and states fared
A majority of states saw a significant increase in central line infection rates, with West Virginia and New Mexico experiencing the biggest increases of more than 180%.
On average, hospitals nationwide scored lower in late 2021 and 2022 than in 2019 on performance measures like nurse and doctor communication, staff responsiveness and education on medicine and discharge information.
The declines are a departure from pre-pandemic data that showed industrywide improvements.
Among hospitals, 29% earned an "A," 26% a "B," 39% a "C," 6% a "D," and less than 1% an "F.” Nearly 60% of hospitals maintained the same grade from the fall 2022 report.
New Jersey, Idaho and Utah were the states with the highest percentages of “A” hospitals, with around 50% earning top marks. Delaware, North Dakota and Washington, D.C., fared the worst by this measure, with no hospitals receiving "A" grades.
Where improvements were made
Despite considerable lapses in care quality over the past year, one bright spot was safety improvements made by poorer-scoring hospitals, Binder said.
Connecticut went from ranking 31st out of the states in its number of “A” grades to ranking fifth. South Carolina, which ranked 21st, jumped to seventh place.
A number of safety-net hospitals saw gains as well. Located in Chicago, St. Bernard Hospital received its first “A” just two years after receiving an “F” grade.
In the past few months, the Leapfrog Group has also seen a reduction in infection rates, meaning the next set of safety grades will be significantly improved, Binder said. Between spring 2021 and spring 2023, the average rate of Clostridioides difficile infections decreased by 15%.
Linking workforce issues, patient safety
Health systems need to address workforce burnout and patient safety issues at the same time as the two are closely related, Binder said.
“It is clearly something that can affect burnout, workforce shortages and can affect the very safety of the workforce,” she said.
As hospitals review their performance on safety measures, many are attempting to reinforce their infection control and reduction practices by spending time with staff to better understand the necessary resources and care environment to support change, Demehin said.
"Ultimately, improving quality and safety relies on the talented people who deliver care in our organizations and keeping them engaged and happy," he said. "Giving them the opportunity to help us identify opportunities for improvement is an important part of making progress."