‘A’-grade hospitals have 50% fewer avoidable deaths

It is much safer to receive care at an “A” hospital versus a “B,” “C,” “D” or “F” hospital, according to new analysis led by Matt Austin, PhD, assistant professor at the Armstrong Institute for Patient Safety and Quality and the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine. 

Leapfrog contracted with Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality on a new analysis estimating the number of avoidable deaths at hospitals in each grade level. The analysis finds that despite considerable improvement in the safety of hospital care since the Score’s launch in 2012, avoidable deaths remain high. 

Findings point to a 9% higher risk of avoidable death in B hospitals, 35% higher in C hospitals, and 50% higher in D and F hospitals, than in A hospitals.

The Hospital Safety Score  estimates patients’ relative risk of avoidable death from errors, accidents, and infections and  grades hospitals with an “A,” “B,” “C,” “D,” or “F.” The Hospital Safety Score is the only rating that focuses primarily on errors, accidents, and infections in hospitals. 

Of the 2,571 hospitals issued a Hospital Safety Score, 798 earned an “A,” 639 earned a “B,” 957 earned a “C,” 162 earned a “D” and 15 earned an “F.”

Compared to “A” hospitals, the relative risk of an avoidable death is 8.5% higher in “B” hospitals, 35.2% higher in “C” hospitals, and 49.8% higher in “D” and “F” hospitals.

Binder

“It is important to recognize that these results reflect average hospital performance in each grade category and individual hospital performance within a letter grade may vary,” says Leah Binder, president and CEO of The Leapfrog Group. “We’re able to understand how many lives we can save each year through this research.”

The analysis calculated 206,021 avoidable deaths in U.S. hospitals each year and estimated that 33,459 lives could be saved every year if “B,” “C,” ”D,” and “F” hospitals had the same safety performance as “A” hospitals.

Avoidable deaths can be due to any number of outcomes measures that are included in the Hospital Safety Score. For example, patients that contract a Catheter-Associated Blood Stream Infection (CLABSI) face an extremely high risk of death, as these infections are often fatal.

Mobley

“Multiple studies have shown that CLABSI is entirely preventable, and many hospitals have achieved a rate of 0 CLABSIs over a period of years,” says Erica Mobley, director of communications & development at The Leapfrog Group. “Patients can also die from falls, air embolisms, or complications from a foreign object retained after surgery.”

Problems with patient safety are a major hazard to the life, health, and well being of covered enrollees, and costly, Binder says. She points to study in JAMA that found that commercial insurance paid $39,000 extra on average every time there was a surgical site infection at a hospital system in the South, and Leapfrog’s evidence-based calculator suggests that employers pay about $8,100 extra for every admission.

Next: Hospitals that make the grade

Making the grade

“A” hospitals maintain a laser focus on safety that permeates from executive leadership down through all levels of staff, according to Mobley.

“These hospitals recognize that patient safety is not something that can be achieved once and then passed aside while other areas of care are focused on; it must be something hospitals think about and apply in practice every single day,” she says.

Plans should point their members to the Hospital Safety Score website or app, or follow the lead of several plans who have integrated the Hospital Safety Scores into their online provider tools, according to Mobley.

“They should educate their members that the Hospital Safety Score should be the first thing they consult before choosing a hospital, as hospital safety permeates all areas of care, whether a patient needs open heart surgery or stitches in the ER,” she says.

After finding a hospital in their community with a satisfactory Hospital Safety Score, patients should then look to identify the hospital with the highest quality for the procedure for which they need care, such as a hospital with good outcomes on knee replacement or a hospital with a low C-section rate for women who need maternity care.

“Plans should also educate members that even in the safest hospitals, mistakes still happen, and patients should be vigilant to protect themselves while in the hospital,” Mobley says.

For example, patients should ensure their care providers are washing their hands before they approach them and make sure they bring a loved one to the hospital with them to serve as their advocate.

Based on this analysis Binder and Mobley have this advice for executives:

1.   Make the Hospital Safety Scores available to members.

2.   Encourage employers to consider the scores in contracting with hospitals and developing steerage strategies or narrow networks.

“Hospitals with low Hospital Safety Scores are more likely to cause additional harm to the patient that could result in higher costs for the plan and employer, not to mention the drop in employee productivity and retention,” says Mobley. “As employers increasingly look to achieve value with their healthcare dollars, they would be wise to choose the safest hospitals for care.

A medical error that harms an employee carries zero value.”

Other highlights of the report include:

• 153 hospitals earned the “Straight A” since 2013 designation, which calls attention to hospitals who have consistently received an “A” grade for safety in the last three years of Hospital Safety Scores. 


• Maine, which has had the highest percentage of “A” hospitals for the last four rounds of the Score, dipped to second behind Vermont, where 83% of its hospitals achieved an “A.” This is the first time Vermont has received the number-one spot. 


• For the third year, zero hospitals in the District of Columbia received an “A” grade. Similarly, Arkansas and Wyoming had no hospitals with an “A” grade. 


Next: Patient experience vs. satisfaction

The patient experience

The spring 2016 Hospital Safety Score includes five measures of patient experience (Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS).

The HCAHPS survey is a measure of patient experience in the hospital.

“Patient experience is often seen as different from patient satisfaction,” explains Binder. “Many of the HCAHPS domains target the exchange of information between the patients and their care team, a vital aspect of safe healthcare delivery. Without effective communication, providing safe care becomes extremely difficult.”

These measures are collected using a standard patient survey that is administered to inpatients between 48 hours and six weeks after they have been discharged from the hospital, providing the public with a more complete picture of the care being provided at hospitals. Those measures are as follows:

• Communication about medicines. This reflects patients’ feedback on how often hospital staff explained the purpose of any new medicine and what side effect that medicine might have.

“Effective communication about medicine prevents misunderstanding that could lead to serious problems for patients. Hospitals with better communication about medicine have been shown to have lower rates of mortality, sepsis and pulmonary embolism or deep venous thrombosis,” Binder says.

• Communication about discharge. This measure summarizes how well the hospital staff communicated with patients about the help they would need at home after leaving the hospital. In addition, it explores how often patients reported that they were given written information about symptoms or health problems to watch for during their recovery.

“Educating patients on steps they need to take during their recovery at home reduces the chance that a patient will need to be readmitted to the hospital and hospitals that provide better patient experience of care have higher adherence rates to clinical guidelines, lower risk-adjusted mortality rates and lower readmission rates,” Binder says. “What’s more, hospitals with better discharge communication ratings have been shown to also have shorter lengths of stay and lower rates of mortality, sepsis and pulmonary embolism or deep venous thrombosis.” 

• Nurse communication. This measure explores how well patients feel their nurses explained things clearly, listened carefully to the patient and treated the patient with courtesy and respect.

“Effective communication between nurses and patients can prevent errors like medication mix-ups or misdiagnoses,” Binder says. “Additionally, hospitals with better nurse communication ratings have been shown to have lower rates for respiratory failure and pulmonary embolism.”

• Responsiveness of hospital staff. This looks at patients’ feedback on how long it takes for a staff member to respond when a patient requests help.

“If a patient is in pain, experiencing new symptoms or cannot reach the bathroom themselves, it’s essential that hospital staff respond quickly to address the situation,” Binder says. “This is critical to ensuring safe care for patients in the hospital. For example, hospitals with better staff responsiveness ratings have been shown to have lower rates of respiratory failure, surgical complications, and pulmonary embolism or deep venous thrombosis.

• Doctor communication. This measure summarizes how well patients feel their doctors explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect. Effective communication between doctors and patients can be reassuring to the patients and can help prevent errors such as medication mix-ups or misdiagnoses.

“Hospitals with better doctor communication ratings have been shown to also have lower rates of hospital acquired conditions and patient safety indicators,” Binder says.