Leapfrog Group safety grades steady for most hospitals despite pandemic

The COVID-19 pandemic led to mixed results on hospital safety, according to the latest data from the Leapfrog Group.

The Leapfrog Group assessed approximately 2,800 general acute care hospitals for the report published Tuesday. Among those, 20.3% got higher safety scores in spring 2022 than a year before and 22.4% received lower grades. The majority—57.2%—rated the same in 2021 and 2022.

North Carolina had the highest share of hospitals earning "A" grades at 59.8%. Virginia and Utah followed closely behind, with 59.2% and 55.6% of hospitals at "A" levels respectively.

Wyoming, the District of Columbia, West Virginia and North Dakota fared the worst in that regard, with no hospitals receiving "A" grades.

"We sympathize with the stress that hospitals are under," Leapfrog Group President and CEO Leah Binder said. "At the same time, though, people are entrusting their lives in hospitals, so we hold them to a higher standard. Even under all that stress, we need them to be as safe as possible for their patients."

Ranking hospitals based on their abilities to protect patients from preventable errors, accidents, injuries and infections enables them to identify opportunities to improve and to set goals, Binder said.

This year, 33% of hospitals received "A's," 24% received "B's," 36% received "C's," 7% received "D's" and less than 1% received "F's." Although grades for individual hospitals have shifted, the overall picture is mostly unchanged from 2021.

The consequences for patients can be significant, according to a study Johns Hopkins Medicine researchers published in 2019. At "B"-rated hospitals, patients are 35% more likely to die from preventable errors than at hospitals with "A" grades. The estimated relative risk of avoidable death is 91.8% higher at "D" and "F" hospitals than at "A" hospitals.

Guaranteeing safety and quality requires accountability, Binder said. Governing boards must prioritize these goals and CEO compensation should be linked to performance, she said.

Health systems lacked complete information about how their safety systems performed while they were contending with the ongoing pandemic, which accounts for the downgrades at some facilities, said Nidia Williams, vice president of quality and safety for Lifespan Health System in Providence, Rhode Island. Given the intensified focus on safety and infection control during a global outbreak of a highly contagious virus, the negative results were unexpected, she said.

"We didn't realize that the patient population was different, and required an awful lot of care, treatment, time, energy and resources that we weren't necessarily prepared for," said Williams, who is president-elect of the National Association for Healthcare Quality's board of directors.

Numerous factors contributed to hospitals' safety grades fluctuating during this period, said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association. For instance, travel nurses may not be fully trained on a hospital's safety and infection control practices, Foster said.

And patients who delayed care because of the pandemic may have arrived sicker and required interventions such as ventilators or catheters that pose risks of infection and other adverse events, said Akin Demehin, the AHA's senior director of policy.

In spite of the challenges, hospitals have endeavored to be diligent about tracking ways the pandemic affected safety, Demehin said. More than 90% continued to submit healthcare-associated infection reports even though the Centers for Medicare and Medicaid Services made that optional, he said.

Health systems have begun using technology and predictive analysis to anticipate and prevent potential safety incidents, said Rick Kes, a healthcare industry senior analyst at RSM. These technologies can allow hospitals to pinpoint where and when safety events occur and take steps to address those conditions, he said.

The Leapfrog Group issued a separate report Tuesday that analyzes hospitals' submissions to the Hospital Consumer Assessment of Healthcare Providers and Systems Survey. In general, patients' opinions of their experiences at inpatient facilities have declined during the pandemic, the report shows. Patients rated care transitions, hospital staff responsiveness and medication communication least favorably. The organization issued its findings about outpatient facilities last week.