Survey finds hospitals lagging behind on safety

Progress made on wrong-site surgeries

The results are mixed in the first-of-its-kind survey of hospital safety practices conducted by The Leapfrog Group, a Washington, DC-based organization founded to promote improvement in health care safety.

The Leapfrog Hospital Quality and Safety Survey, which included responses from more than 1,000 hospitals, is the first to include measures that cover all 30 of the safety practices endorsed by the National Quality Forum (NQF). (The safety practices can be found on the NQF web site,

"My general reaction is that while we have made some progress in agreeing on what practices should be implemented universally to reduce mistakes; we are lagging behind where we should be in terms of actually implementing those practices," says Suzanne Delbanco, PhD, CEO of The Leapfrog Group.

"NQF’s release of its report identifying the 30 practices for safer health care was the impetus for the survey," she continues. "The NQF said, Here are 30 practices that should be instituted everywhere. We were already collecting data on three [computerized physician order entry, ICU (intensive care unit) physician staffing, and evidence-based hospital referral], but 27 were not touched. We felt if we wanted to have a national consensus, we should collect data on all of them, so consumers can see which hospitals do and don’t practice them."

Good news, bad news

The Leapfrog survey did show significant progress in two areas:

  • Eight in 10 hospitals have implemented procedures to avoid wrong-site surgeries.
  • Seven in 10 hospitals require a pharmacist to review all medication orders before medication is given to patients.

Even here, Delbanco, says, there still is room for improvement. "Of course, they all should be 100%," she asserts. "But what really worries me is that some patients go to a hospital where there are no protocols in place. What’s good is that there is a lot of attention on wrong-site surgeries, for example; hospitals have responded, and policies are in place."

In many other areas, however, that is not the case. Leapfrog cites four examples of areas that still need improvement — not, Delbanco emphasizes, because they are particularly egregious or because they rank high on Leapfrog’s priority list. Rather, they simply illustrate the kind of advances that still must be made:

  • Seven in 10 hospitals report they do not have an explicit protocol to ensure adequate nursing staff or a policy to check with patients to make sure they understand the risks of their procedures.
  • Six in 10 lack procedures for preventing malnutrition in patients.
  • Five in 10 report they do not have procedures in place to prevent bed sores (pressure ulcers).
  • Four in 10 hospitals lack policies requiring workers to wash their hands with disinfectant before and after seeing a patient.

"It would be most interesting to ask the hospitals why [they have not adopted these policies and procedures]," Delbansaysdds. "If I had to guess, I’d say that some of these are so obvious that it may not occur to hospitals that they have to take the time to establish policies and procedures and see if everyone is following them. Take hand washing, for example: The institution may think it’s so obvious that it’s not necessary to take time to see if they have a policy about that, or if they have stations where staff can wash."

Survey offers roadmap

It was Leapfrog’s intent that the very structure of the survey spur hospitals to make safety improvements. "We designed a section of the survey as a kind of roadmap; the very process of filling it out may lead hospitals to take steps they might otherwise not have taken," Delbanco observes.

For each of the 27 safety practices addressed, she explains, the respondent is asked four specific questions:

  • How aware is the hospital of its performance?
  • Please comment on whether anyone on staff is held accountable for performance in that area, i.e., is their compensation tied to quality metrics?
  • Has the hospital been able to improve its performance?
  • What actions has it taken to improve its performance?

"By answering those questions, they may say, Gosh, maybe we should be measuring these things or have ties to compensation,’" Delbanco points out. "Or, if they do not know how to do something, they may be inspired to seek outside help. It almost leads people through a work plan."

Leapfrog does not have a strict schedule concerning future surveys. "As research comes out and makes strong suggestions for us to revise our recommendations, or new standards come out, we will expand it," she says. "Right now, the plan is to release another survey in 2006."

Need More Information?

For more information, contact:

Suzanne Delbanco, PhD, CEO, The Leapfrog Group, 1801 K St. N.W., Suite 701-L, Washington, DC 20006. Phone: (202) 292-6711. Web site: