Latest Leapfrog Survey Finds Hospitals Lagging in Quality Goals

[June 1, 2009, AJHP News]

Kate Traynor

BETHESDA, MD 15 May 2009—The Leapfrog Group's annual hospital survey report, released in April, found that hospitals have a long way to go to fully implement the organization's recommendations for improving the safety and efficiency of patient care.

"Hospitals are making great strides and great efforts," said Leah Binder, chief executive officer of the Leapfrog Group, during an April 15 media telebriefing to unveil the report. "There are examples in here of outstanding innovations at hospitals, of absolute commitment to quality that is truly admirable."

But she said the overall survey results "are simply not adequate for the most expensive health care system in the world and what should be the best health care system in the world."

Founded in 2000 by the Business Roundtable, the Leapfrog Group is a voluntary member organization whose goal is to improve the quality and value of health care services funded by private employers. Leapfrog's supporters include its members, the Robert Wood Johnson Foundation, and the Agency for Healthcare Research and Quality.

Leapfrog's 2008 survey of nearly 1300 U.S. hospitals in 44 states found that only 7% of respondents met the organization's current standards for using computerized prescriber-order-entry (CPOE) systems.

"We need major improvements in the percentage of hospitals that have CPOE systems," Binder said. "This is a known method for reducing medication errors. And medication errors are the number-one safety error in hospitals. So this needs to happen."

Leapfrog's standard requires that prescribers enter at least 75% of medication orders using a CPOE system that includes error-prevention software. In addition, the system must issue alerts identifying for prescribers at least half of common, serious prescribing errors.

CPOE adoption among survey respondents' hospitals was down from 11% in 2007. The report attributed the four-percentage-point decline to the addition of a new requirement that hospitals use Leapfrog's CPOE evaluation tool to test their system.

Barbara Rudolph, director of Leapfrog's Leaps and Measures, said that urban academic medical centers and children's hospitals are the biggest adopters of CPOE systems. Binder said she hopes federal economic stimulus funding will help speed the adoption of CPOE in hospitals.

The 2008 hospital survey found that 32% of hospitals complied fully with the safe practices elements of Leapfrog's standards. This refers to a set of 13 policies and procedures endorsed by the National Quality Forum—including active pharmacist participation in the medication-use process. The overall goal of the practices is to reduce patient harm in hospitals.

"We'd like to see improvements in safe practices," Binder said. "It's an area where we are seeing fairly good results but not great. And these are well-known practices and well-known policies that have been endorsed and in the public domain for a long time."

A report in the April 1 issue of the Journal of the American Medical Association examined data on 155 hospitals that had completed the safe practices portion of Leapfrog's 2006 hospital survey. According to the report, no correlation was found between a hospital's safe practices score and patients' risk of death.

Binder explained that the study examined just one portion of Leapfrog's standards, not the bulk of the elements by which participating hospitals are assessed.

"The majority of the Leapfrog survey is established to be directly correlated with mortality," Binder said. "Safe practices, we just believe, are very positive important practices that hospitals should have in place if they are a safe and quality facility."

According to the survey, 31% of participating hospitals meet Leapfrog's staffing recommendations for intensivist-managed care in general medical, surgical, and neurologic intensive care units. The standard requires that an intensivist be available seven days a week, eight hours a day, and additionally reachable by pager within five minutes.

Binder said most of the information collected by Leapfrog is not otherwise in the public domain, and she credited participating hospitals for volunteering information that increases the ability to measure the quality of the nation's health care system.

Hospital-level results from the 2008 survey are available at Leapfrog's website, www.leapfroggroup.org.