Most hospitals lack in quality, cost-effectiveness, Leapfrog survey shows

Most hospitals fail to achieve quality and cost effectiveness standards set by The Leapfrog Group, according to a survey Leapfrog released Wednesday.

"As the Obama administration and Congress consider healthcare reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation's $2.3 trillion annual investment," said Leah Binder, CEO of Leapfrog, a healthcare watchdog organization. "According to our data, a majority of hospitals have significant safety and efficiency deficits."

"As the president has often stated, a reformed high value healthcare system needs to be cost-effective. Unfortunately, few hospitals are meeting Leapfrog's newly established efficiency measure standards – the first such data available in the public domain," said Binder.

Among surveyed hospitals, efficiency standards -– defined as highest quality and lowest resource use – are met by only 24 percent of hospitals for heart bypass surgery, 21 percent for heart angioplasty, 14 percent for heart attack care and 14 percent for pneumonia care.

Other highlights of the 2008 hospital survey include:

• Only 7 percent of hospitals meet Leapfrog medication error prevention (CPOE) standards and few hospitals are meeting mortality standards.
• Low percentages of reporting hospitals are meeting volume and risk-adjusted mortality standards or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives:
  • 43 percent for heart bypass surgery;
  • 35 percent for heart angioplasty;
  • 32 percent for high-risk deliveries;
  • 23 percent for pancreatic resection;
  • 16 percent for bariatric surgery;
  • 15 percent for esophagectomy;
  • 7 percent for aortic valve replacement; and
  • 5 percent for aortic abdominal aneurysm repair.
• Sixty-five percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs).
• Seventy-five percent do not meet the standards for 13 evidence-based safety practices, ranging from hand washing to nursing staff competency.
• Only 26 percent and 34 percent of reporting hospitals are meeting standards for treating two common acute conditions, heart attacks (AMI) and pneumonia, respectively.
• Only 30 percent and 25 percent of hospitals are meeting standards to prevent hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.

"In spite of huge opportunities for improvement, many hospitals are, in fact, demonstrating quality excellence and serving as role models," said Binder. "We need to take the lessons learned from the best hospitals and use these to move the status quo forward so all Americans have access to safe, cost-effective care."

Notable improvements by surveyed hospitals in 2008 include:

• Thirty-one percent of hospitals now meet the Leapfrog ICU staffing standard, up from 10 percent in 2002.
• Hospitals with all of Leapfrog's recommended policies in place to prevent common HAIs jumped from 13 percent to 35 percent between 2007 and 2008.
• Sixty percent of hospitals have agreed to implement Leapfrog's "Never Events" policy when a serious reportable event occurs in their facility.

"Progress on patient safety is moving too slowly," said Binder. "Consumers and purchasers of healthcare want hospitals to implement safety standards and procedures known to improve quality and reduce unnecessary injury and death. The safety goals Leapfrog promotes are achievable. More hospitals should be meeting the Leapfrog standards for common and high risk procedures."

The voluntary Leapfrog Hospital Survey results are as of Dec. 31, 2008, and include 1,276 hospitals in 37 major U.S. metropolitan areas, representing 48 percent of the urban, general acute-care hospitals (53 percent of hospital beds in these areas),

Individual hospital results can be viewed and compared with other hospitals at www.leapfroggroup.org.