Low Percentage of U.S. Hospitals Meet Goals for Reducing Mortality

There are many risks associated with hospital stays, but the main priority in every hospital is patient safety. However, the 2008 Leapfrog Group survey shows that the majority of U.S. hospitals did not meet the standards shown to help reduce mortality. Out of the 1,282 hospitals taking part in the voluntary survey—which represents approximately 48 percent of the urban medical centers—many of them are falling short of mortality reduction measures and are not delivering care efficiently, the nonprofit’s yearly report stated.

The CEO of Leapfrog, Leah Binder, said, “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.”

This new survey came just weeks after the Journal of the American Medical Association published a study that showed the adherence to National Quality Forum safety standards, which include such measures as handwashing and having a competent nursing staff, do not result in lower rates of mortality. However, Binder states that the new survey focuses on factors that are known to positively reduce mortality, such as the staffing levels of physicians in the intensive care units and the hospitals meeting prescription order-entry standards.

Barbara Rudolph, Ph.D. from the Leapfrog Group, said that the hospitals are not doing a good job at following the recognized protocols for high-risk procedures, the kind of procedures that can reduce the risk of death significantly. For instance, less than half of all of the hospitals that were surveyed met Leapfrog’s volume and risk-adjusted mortality standards for the surgery for an artery bypass graft. However, this is still a major increase since last year, when only approximately 10 percent of the hospitals met the nationally recognized protocols to help reduce deaths from bypass. According to Binder, this improvement is largely in part to more of the states publicly reporting their outcomes for bypass surgery.

The leapfrog survey also found:

• Approximately 35 percent of the hospitals met the standards for mortality for percutaneous coronary interventions.
• Approximately 5 percent of the hospitals met the standards for mortality for aortic abdominal aneurysm repair.
• Approximately 16 percent of the hospitals met the standards for mortality for bariatric surgery.
• The surveyed found that 65 percent of the hospitals did not have all of the recommended policies in place to help prevent common hospital-acquired infections. However, this is a 22-point improvement from 2007 when approximately 87 percent of the hospitals were lacking strong policies for infection-prevention.
• Half of the hospitals that participated in the survey have implemented all the recommended policies for preventing aspiration and ventilator-associated pneumonia and central venous catheter-related infections in the bloodstream.
• Only 25 percent of the hospitals have fewer than 0.07 injuries that were hospital-acquired per 1,000 inpatient days.

Dr. Rudolph said, another change that could be made in the hospitals that can help prevent deaths is a computerized prescriber order entry programs, or CPOE. Already being used widely, these systems could reduce such adverse events by approximately 88 percent and prevent more than 3 million errors in medications every year. However, only 77 percent of the hospitals actually meet Leapfrog’s medication error prevention standard, which includes having the hospitals enter at least 75 of their medications for inpatients through CPOE. Although the adherence rate to use the CPOE standard, it has been steadily increasing since 2002.

The hospitals did fare better on a third component that has been linked to the outcomes of mortality, appropriate staffing in the intensive care unit’s. Dr. Rudolph said, “You can see a reduction overall of 40 percent mortality when there is appropriate staffing by trained intensivists. If this were implemented in all urban hospitals, we could prevent 54,000 deaths annually.”

The survey also showed that approximately one-third of all of the hospitals met the Leapfrog staffing standards for the intensive care unit’s in 2008, which is a significant improvement over the 10 percent that was reported in the year 2007. Leapfrog’s ICU staffing standard requires for the hospitals to use intensivists for care management in all surgical, general medical, and neurological intensive care units eight hours daily and also the additional availability of contacting the proper medical staff by pager within five minutes.

Leapfrog also surveyed the hospitals on the efficiency measures, which is defined as delivering the highest quality with the lowest utilization of resources. The survey found that only a quarter of all the hospitals were efficient which it came to coronary bypass surgery, and only one-fifth of the hospitals deliver care efficiently for coronary angioplasty. Also, only 14 percent of the hospitals used their resources wisely for treating pneumonia and heart attacks.

According to Binder, the results of the survey are the only publicly available data to actually measure the efficiency standards, an increasingly important indicator as the debates for healthcare reform are focusing on improving the efficiency of the U.S. system