Leapfrog Group safety grades show progress on infection control

Hospitals have made dramatic gains in reducing their infection rates but continue to struggle with improving the patient experience, leading to lower grades for some providers from The Leapfrog Group.

The nonprofit watchdog organization’s fall 2023 report revealed a 17.5% decrease between April 2021 and December 2022 in the average standard infection ratio of central line-associated bloodstream infections. Average ratios for MRSA cases and catheter-associated urinary tract infections decreased by 15.3% and 14.7%, respectively.

Related: CMS updates HCAHPS survey amid declining scores

Overall, hospitals' safety performance has remained fairly stable. 

Among hospitals, nearly 30% earned an “A,” 24% a “B,” 39% a “C,” 7% a “D,” and less than 1% an “F.” Around 1,870 hospitals, or two-thirds of those graded, maintained their grade from the spring 2023 report. Thirty-eight hospitals fell by two grades, and 40 increased by two grade levels. 

Where Leapfrog saw improved safety efforts

Progress on reducing infections is likely due to increased focus from hospital leadership and fewer surges of critically ill COVID-19 patients, said Leapfrog Group President and CEO Leah Binder.

After several years of worsening scores surrounding hospital-acquired infections, more than 66% of facilities were able to boost their performance on one Leapfrog Group infection measure. Another 19% improved on all three infection measures--MRSA cases, central line infections and urinary tract infections. 

While that is good news for patient safety, hospitals have a way to go before returning to pre-pandemic levels and should focus on reaching even lower infection rates, Binder said.

At one health system, increasing recruitment efforts, reducing turnover and supporting clinical work with advanced analytics have been key strategies in addressing hospital-associated infections. 

Since cases of COVID-19 began subsiding, AdventHealth, based in Altamonte Springs, Florida, has used fewer agency nurses, instead hiring and training thousands of nurses to fill positions and spending more time with patients to reduce safety risks, said Dr. William Scharf, the system’s executive clinical director of quality and safety. 

The system’s central line infection rates are lower than they were heading into 2020, Scharf said. 

How hospitals fared

Utah was the state with the highest percentages of “A” hospitals, with around 52% earning top marks. Vermont, Wyoming, Delaware, North Dakota and Washington, D.C., fared the worst, with no hospitals receiving "A" grades.

All states saw significant decreases in patient experience scores between the fall of 2021 and the fall of 2023, with hospitals in New Mexico, New Hampshire and Florida experiencing the most significant declines.

Of the 38 hospitals that dropped two letter grades, most went from an "A" to a "C," like Sutter Medical Center in Sacramento, California, and SSM Health St. Clare Hospital in Fenton, Missouri.

Only one facility, Memorial Hospital of Gardena, California, went from a "C" to an "F."

Where hospitals fell short

One major area of concern outlined in the report is hospital performance on patient experience measures, which draw from results of the Centers for Medicare and Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems survey.

For the second year in a row, hospitals on average scored worse on measures like nurse and doctor communication and discharge information.

Between the 2019 and 2022 reporting periods, hospitals' scores on communication about medicines and staff responsiveness dropped by 4.9% and 4%, respectively.

“It is disturbing, as typically we don't see a lot of change in patient experience scores over time; they have tended to remain flat,” Binder said. “Not this time. In addition to deteriorating during the pandemic, they also deteriorated post-pandemic.”

Workforce shortages and pandemic-related protocols have meant clinicians are less available to answer call buttons in a timely manner and talk with patients in their rooms, she said. That, in turn, has led to decreased patient satisfaction with the quality of their care. 

To improve patient experience scores and address gaps in communication at its facilities, Advent Health is trying out evidence-based practices like multidisciplinary rounding, daily visits from nursing leaders and hourly patient visits from clinical staff, Scharf said.

Though most of AdventHealth’s hospitals are making “A” grades, a few categories received a  “C” or “D,” which Scharf attributed to recently acquired facilities that experienced years of disinvestment under different ownership.

“It takes roughly three years at minimum to turn a facility around, and even then there's no guarantee,” he said. “COVID-19 certainly set us back with most of these hospitals on that goal.”