Poor hospital performance on 16 patient safety measures causes more than 161,000 deaths annually, according to a recent report from the Leapfrog Group and Johns Hopkins — but that is a decrease from 2016 figures.
The Spring 2019 Leapfrog Hospital Safety Grades looks at deaths due to errors, accidents, injuries, and infections, comparing them to the hospitals’ A through F Leapfrog scores.
There was a 92% greater risk of avoidable death at D and F hospitals than at A hospitals, the report says. The analysis included 2,600 hospitals.
Compared to A hospitals, there was an 88% greater risk of avoidable death at C hospitals and a 35% greater risk at B hospitals.
“Even A hospitals are not perfectly safe, but researchers found they are getting safer,” according to the report. “If all hospitals had an avoidable death rate equivalent to A hospitals, 50,000 lives would have been saved, vs. 33,000 lives that would have been saved by A-level performance in 2016.”
Current data suggest 160,000 lives are lost each year to avoidable medical errors, Leapfrog says. The 2016 report estimated 205,000 avoidable deaths annually. (The current report is available online at: https://bit.ly/2WNecia.)
Leapfrog also recently released its 2019 Maternity Care Report, which found that only 20% of the reporting hospitals are fully in compliance with Leapfrog’s standards on cesarean sections, early elective delivery, and episiotomy rates. (The report is available online at: https://bit.ly/2W18gB2.)
The report on lives lost shows clear progress in improving patient safety, says Leah Binder, CEO of The Leapfrog Group in Washington, DC.
“Typically, when we talk about patient safety, we don’t talk about improvement because it seems like an intractable problem that never goes away. Finally, we have very good news,” Binder says. “Forty-five thousand people not dying each year is a lot of people. This is encouraging, and we should at least take one pat on the back for American hospitals that they are on the right track for addressing safety.”
But the praise is limited, Binder says, because 160,000 lives lost annually is still a huge problem.
“We still have a long way to go before we can pop the champagne, but we’re on the right track, and it has been a very long time since any of us could say anything positive about our effectiveness in addressing patient safety,” Binder says.
Binder encourages risk managers to look at whether their hospitals are declining to report some of the data included in the report. Some hospitals are not transparent about data that might not be flattering, so risk managers should consider that a red flag and address the underlying issues, she says.
The Leapfrog report is encouraging, suggesting that hospitals are making progress on reducing patient harm, and that efforts have resulted in an overall reduction in lives lost, says Lisa Simm, RD, MBA, CPHQ, CPPS, CPHRM, FASHRM, manager of risk management with Coverys, a liability insurer based in Boston.
Simm notes that healthcare executives have openly expressed some justifiable criticism of the Leapfrog Safety Score methodology, including concerns regarding the validity of the self-assessment/self-reporting nature of the survey, lack of adequate severity adjustment for all outcome measures, limitations in the use of payment codes to collect clinical quality data, variation in data collection time periods between measures taken from January 2015 to March 2018, and questions as to the meaningful nature of benchmarking hospitals of all sizes, serving very different populations — especially when not all hospitals can participate in all the outcome measures.
However, the Armstrong Institute of Patient Safety and Quality of Johns Hopkins Medicine, understanding these limitations, joined forces with Leapfrog in an effort to test solutions. Simm says they are using a scientific approach in an effort to advance patient safety and quality and specifically achieve meaningful ways to provide purchasers, patients, and families with hospital quality of care information to help them determine value.
“This report should serve to substantiate patient safety achievements and the need for improvement in both patient safety and our ability to measure quality of care and patient safety,” Simm says. “This report is a reminder that the purchasers of insurance and their patients are certainly interested in making informed healthcare purchasing decisions that consider the quality of healthcare provided in hospital care.”
Quality and risk management professionals should remember that the ability to measure quality and predict risk is in its infancy in healthcare, Simm says.
“The estimated mortality rate of patient safety events in this report has not taken into account a severity adjustment or comorbid conditions for each outcome measure in a given hospital, ICU, or obstetrical unit, and a hospital can receive a safety score of A without reporting values on all their outcome measures,” she says. “The report is using the best of what we have available.”
Quality improvement and risk management professionals and clinicians should be involved with suggesting and developing the best measures to evaluate hospital care, Simm says.
“This is not easy, but they are the experts who are best positioned to do so. They should be involved at the national or regional level with their professional societies and expert measure development coalitions, and they should share their expert provider input on the most valid and reliable measures used for benchmarking,” she says.
This report also is a reminder of the leadership role risk management and quality improvement professionals have in prioritizing and driving improvement within their own organizations, Simm says.
“This report, like other studies, supports the premise that patient harm is likely underreported and underestimated and that risk management and quality improvement professionals need to work together to develop more robust adverse event identification systems and take that one step further by developing early warning systems that can help prevent harm from occurring,” she says. “There is a need for improved outcome measurement and increased process measures that align with outcomes. The signals provided by this report need to be considered with all the other quality and patient safety signals an organization is receiving.”
The report also signals the need for further development in outcomes measurement that looks at the entire community health system and not just the hospital in isolation. Hospitalization can be a factor of the health of the population and whether appropriate supports are available in the community for a given population, she notes.
Benchmarking with best-in-class hospitals can be effective in formulating improvement in operations and processes, Simm notes.
“Appropriate benchmarking cohorts make any benchmarking data more meaningful. Not all patients are alike, and our hospitals service clients with differing complexities in clinical need, comorbidities, social determinants, and community resources,” she says. “Data transparency and the need to benchmark will continue to play a role in performance improvement and is useful to purchasers and their patients. Hospitals will want to select the most comparable organizations with target levels of performance they are looking to achieve.”
• Leah Binder, CEO, The Leapfrog Group, Washington, DC. Phone: (202) 292-6713.
• Lisa Simm, RD, MBA, CPHQ, CPPS, CPHRM, FASHRM, Manager, Risk Management, Coverys, Boston. Phone: (800) 225-6168.