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Thursday, Mar 28, 2024

Leapfrog Group Hospital Safety Scores Offer Surprises

The grades are out, and it’s not what you’d expect. For the first time, the nationally recognized Leapfrog Group, which tries to use its leverage as a representative of large employers and health care buyers — issued safety grades for 2,652 general hospitals across the country. Ranging from an A to and F, the grades measure safety in hospitals, which despite best efforts, still wind up causing about 400 deaths a day due to errors. Sometimes safety lapses are simple, like not washing hands. Sometimes they are more complex, like failure to follow evidence-based practice for inserting a central line. Here in the Valley region the grades were a bit of a surprise. Hospitals with seemingly the best reputations earned mediocre scores. They include Providence St. Joseph Medical Center, Glendale Adventist Medical Center, Valley Presbyterian Hospital, Antelope Valley Hospital and Henry Mayo Newhall Memorial Hospital. The good news is that more Valley hospitals earned top marks than mediocre marks. Nine scored an A. They include both the Woodland Hills and Panorama City Kaiser Permanente hospitals, Olive View-UCLA Medical Center, West Hills Hospital & Medical Center, Los Robles Hospital & Medical Center, Providence Tarzana Medical Center and St. John Pleasant Valley Hospital in Camarillo. Controversial Prime Healthcare, which has seen its reputation tarnished by accusations of sometimes unnecessarily admitting patients through its emergency department and other practices, also earned an A at both its Encino and Sherman Oaks facilities. In the middle with a B score were Providence Holy Cross Medical Center, Glendale Memorial Hospital and Mission Community Hospital. Northridge Hospital Medical Center and Simi Valley Hospital are still awaiting a grade. As any student anxiously awaiting a report card, and perhaps not finding what they’d hoped, hospitals greeted the news with concern and a bit of resistance. Jan Emerson-Shea, vice president for external affairs at the California Hospital Association noted — rightly so — that the grades are imperfect. She pointed out that Leapfrog Group relied on a combination of publicly available data as well as its own surveys. Hospitals that did not participate in those surveys, she said, seemed to receive a lower score. “The data,” she said, “seems skewed in favor of those who participated in the Leapfrog survey.” What’s more, Leapfrog Group, she said, is not always using nationally adopted measures of safety. For example, the group decided that having an intensivist — a doctor who specializes in intensive care — should be a key measure of safety in an intensive care unit. “It’s a nice idea,” she said. “But they failed to take into account that there are not very many of those doctors around. And they are very expensive.” Emerson-Shea also noted that some Centers for Medicare and Medicaid Services (CMS) measures Leapfrog used have been discontinued. And she pointed out — as have many hospitals nationwide — that the latest safety measures some hospitals instituted were not counted. All good points. But we are talking life and death. When hospital staff fails to carry out a simple task like washing hands before every patient contact, dangerous germs spread. When they fail to follow nationally accepted standards for how to insert a central line, patients can die. When they fail to use computerized systems to order medications, patients can get the wrong medications. Many of the hospitals that received a C are excellent hospitals. They have superb surgeons and they deserve their reputation. But mistakes happen. Four hundred a day adds up to more than 146,000 lives a year. That’s too many. Organizations like Leapfrog have been advocating for better hospital safety for years. And like everyone, they “have been frustrated by the lack of progress,” as David Knowlton, chair of The Leapfrog Group’s Patient Safety Committee, said. There are many good reports and websites that allow consumers to compare hospitals — from U.S. News & World Reports to HealthGrades to CMS’s own very good Hospital Compare website. But Leapfrog made judging safety simpler and more consumer-friendly. It has consolidated 26 widely accepted measures of safety — including those from CMS, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention. The 26 safety measures were arrived at by a blue ribbon panel of experts ranging from Stanford University’s Dr. Arnold Milstein, a national figure in health care quality, to Dr. Peter Pronovost of Johns Hopkins University, who has written extensively about using checklists to reduce medical errors — the same way pilots use checklists before takeoff. According to the National Transportation Safety Board, 472 people died in airplane fatalities in all 2010; only two of those were from commercial airlines. It pales in comparison to how many still die in a hospital due to mistakes, errors and infections. Taking care of people is complicated business; some would say even more complicated than commercial aviation. But could hospitals learn something from this industry where failure is not an option? Certainly. Could Valley hospitals do better to prevent pressure ulcers, bloodstream infections and medication mix-ups that cost lives? Absolutely. Even the best of the best.

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