Unfavourable findings on U.S. hospitals

Survey reveals improvements could avoid 3,000,000 adverse
drug events, save about 57,000 lives, and reduce healthcare costs by $12 billion. Report: Dot M McSherry of i.t. Communications

The Leapfrog Group is a U.S. organisation of member companies that pay for healthcare services, e.g. corporations, health insurers and local, state and federal government agencies. Established in 2000, its philosophy is that big 'leaps' in healthcare safety, quality and value to patients will be recognised and rewarded. The organisation mobilises purchasing power of its members, representing over 37 million individuals in all 50 states, to reward healthcare organisations that provide high value healthcare services.

Renowned for its research, one of the Group’s most important and highly respected services is the Leapfrog Hospital Survey, which evaluates the safety practices, efficiency, quality and patient outcomes of over 1,300 US hospitals. This annual survey, which began in 2001, is considered to be a very accurate assessment of hospital performance. It measures guidelines and outcomes that are consistent with recommendations from US government agencies and The Joint Commission, the nation’s independent hospital accreditation organisation.
Published this March, the 2008 survey was completed by 1,282 acute care hospitals in 44 states. Its data is the only public source of information on hospital adoption of electronic medication ordering systems, hospital efficiency, adoption of endorsed safety practices, survival predictors, staffing of intensivist physicians in ICUs, and risk adjusted mortality for a selection of high risk procedures.
The Leapfrog Group estimates that if medication ordering systems, intensivist ICU staffing, and use of higher-performing hospitals for high risk procedures were implemented in all urban hospitals in the US, up to $12 billion in healthcare costs could be saved on an annual basis. In addition, 3,000,000 adverse drug events could be avoided, and up to 57,000 lives saved.
Approximately one third of the hospitals fully met at least 90% of Leapfrog’s policies and procedures for 13 safety practices. Findings from the 2008 survey show that the US hospitals, which voluntarily complete the survey, need to make significant improvement. A summary of results include:
Efficiency of providing high quality care and low resource use
24% of the hospitals in the survey met Leapfrog’s efficiency standards for heart bypass surgery, and 21% for heart angioplasty. Only 14% met the standard for treating heart attacks and pneumonia.
These efficiency standards are calculated by evaluating risk-adjusted average length of stay and readmission rates. Hospitals also have to meet fully the quality standards for the particular illness or condition being treated.
Pneumonia and acute myocardial infarction
66% of the hospitals failed to meet all of the evidence-based national guidelines for treating patients admitted with pneumonia. For patients with acute myocardial infarction, the failure rate was 74%.
Nosocomial infections
Only 35% of responding hospitals have implemented all of the policies that the Leapfrog Group recommends to prevent the most common nosocomial infections. This is an impressive improvement, because in the 2007 survey, only 13% did. Half of the hospitals surveyed implemented all the hand-hygiene practices, as well as the policies and protocols for preventing central venous catheter-related bloodstream infections and ventilator-associated pneumonia.
In the US, one in every 20 people treated at a US hospital contracts an infection. Almost 90,000 patients die from these preventable infections.
Hospital-acquired medical conditions
Up to one third of the hospitals met Leapfrog standards for hospital acquired pressure ulcers (bedsores) and patient injuries, such as burns and falls. 30% of hospitals reported fewer than 0.25 pressure ulcers, and 25% reported fewer than 0.07 injuries for every 1,000 in-patient days. There was a wide variability respect to the number of incidents, and 10% of the hospitals reported 1000% more incidents than the hospitals that met the standards of the Leapfrog Group.
Adoption of Leapfrog Group’s high risk procedure standards
If implemented, these standards can reduce a patient’s risk of dying by 200-400%. The Group estimates that if the standards it endorses were fully adopted for eight high risk procedures, 3,000 deaths would be avoided annually. The highest standard adopted was heart bypass surgery (43%) and heart angioplasty (35%), followed by high risk deliveries of babies (32%).
However, 84% failed to meet bariatric weight-loss surgery standards, and 93% failed for aortic valve replacement. Hospitals that passed adhered to nationally endorsed quality of care process measures, performed a high volume of surgeries and had low risk-adjusted mortality rates.
Use of accredited critical care specialists in ICUs
The greatest improvement was shown by hospitals in this category, with 31% of responding hospitals meeting the Group’s criteria and another 7% planning to do so in 2009.
Hospitals are required to use intensivists, or board-certified critical care medical specialists, in ICUs eight hours daily, and be on site within five minutes for the other 16 hours.
This measurement is important because staffing ICUs with intensivists can reduce mortality of patients by 40% on average. Leapfrog estimates that 54,000 deaths and up to $4.3 billion could be saved each year if all urban hospitals with ICUs initiated this type of clinical staffing.
Adoption of Leapfrog’s 2006 Serious Errors Policy
65% of the responding hospitals have adopted the policy, an improvement of 12% since 2007.
Leapfrog has a list of 28 serious medical errors, which include giving a mother the wrong newborn baby when being discharged from the hospital, leaving a foreign object during a surgical procedure in a patient’s body, and wrong -site surgery. Its policy mandates that a root cause analysis of the event be undertaken, the event be reported to a patient safety organisation, the costs associated with the error be assumed by the hospital, and that hospital staff apologise to the patient and family.
Adoption of computerised prescription drug order entry systems
Implementation of e-prescribing is in the forefront of the Obama Administration’s healthcare reform plans. The Leapfrog Group estimates that more than 1,000,000 serious medication errors occur annually in hospitals and that more than $7.5 billion is spent in hospitals alone to deal with the outcomes. Additionally, an estimated 7,000 people needlessly die.
The survey verifies that adoption of these systems is in its infancy in US hospitals. Only 7% of the hospitals fully met the Leapfrog requirement, which included testing the CPOE system with Leapfrog’s evaluation tool.
Details: www.leapfrogroup.org

01.09.2009

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