Leapfrog sees 'significant' infection increases across its largest-to-date release of hospital safety grades

The Leapfrog Group said it has seen industrywide increases in certain healthcare-associated infections among the results of its newly released Hospital Safety Grades, the first edition of its twice-annual watchdog report to include COVID-era data. 

The group has added nearly 200 more hospitals and a handful of new Centers for Medicare & Medicaid Services (CMS) performance measures to the fall edition of its patient safety report card, released Wednesday

Overall, Leapfrog awarded 32% (928 hospitals) of its total 2,901 sample an A grade, 26% (757 hospitals) a B, 35% (1,007 hospitals) a C, 7% (190 hospitals) a D and fewer than 1% (19 hospitals) an F. This spread was roughly proportional to the spring rankings, which used a similar standard deviation from mean cutoffs to rank the participating hospitals.

Four states saw more than 50% of their hospitals receive an A rating: Virginia (56.2%), North Carolina (55.1%), Idaho (53.9%) and Massachusetts (51.7%).

North Dakota, Delaware and Washington, D.C., each did not have a single hospital receive the top mark.

The most recent safety grades suggest “significant variation” across regions and individual facilities, Leapfrog said, underscoring the need for patient tools to review hospital performance when seeking care.

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Additionally, Leapfrog President and CEO Leah Binder told Fierce Healthcare that two outcome measures—central line bloodstream infection (CLABSI) and methicillin-resistant staphylococcus aureus—saw statistically significant decreases across the full sample of 2,901 hospitals since the spring rankings.

On the other hand, she said four other measures—computerized physician order entry, bar code medication administration, Clostridium difficile and death rate among surgical inpatients with serious treatable conditions—saw significant improvements across the board.

“As the pandemic continues, we all have heightened awareness of the importance of hospitals in our communities and in our lives,” Binder said in a statement. “It is critical that all hospitals put patient safety first. Now we have more information on more hospitals than ever before, so people can protect themselves and their families.

The spring’s ratings highlighted 27 “Straight A” hospitals that had consistently received Leapfrog’s highest rating since the launch of its reports. That list of high-performers has now dwindled to 23, with Brigham and Women’s Faulkner Hospital, Saint Barnabas Medical Center, Memorial Hospital Miramar and Huron Valley-Sinai Hospital having lost their spots on the honor roll.

Leapfrog’s grading methods generally follow the same process from report to report. However, the independent watchdog’s newest ranking saw some updates in scope and timeliness.

For the former, Leapfrog has now integrated the CMS Medicare Patient Safety Indicators (PSIs) 90 measure, a composite of 10 outcomes including new additions like postoperative sepsis and in-hospital fall with hip fracture. This increases the total number of individual measures considered in a hospital’s ranking to 31.

RELATED: Leapfrog report highlights hospitals' patient communications, care transition shortcomings

Further, Leapfrog ratings released earlier this year did not include any survey results or outcome data that were compiled following the onset of COVID-19.

Although this is still the case for the majority of the data, Leapfrog’s scoring methodology document indicates that “all five infection measures included in the Safety Grade contain one quarter of 2020 data (7/1/20 – 9/30-20) in addition to three quarters of 2019 data."

Hospitals that submitted a 2021 Leapfrog Hospital Survey also submitted data on computerized physician order entry, ICU physician staffing and bar code medication administration—although the group notes that other included hospitals that did not submit the 2021 survey could still be included with “historical or like facility data” employed for their fall ranking should they meet other participation requirements.

Leapfrog releases its Hospital Safety Grade rankings as a free resource for the public to review the safety processes of their local hospitals. The reports are independently assessed and peer reviewed, according to the organization, with the methodology of the scoring made available online.

Leapfrog’s individual hospital ratings come in the wave of other reports suggesting the pandemic has generally reversed promising gains in preventable safety events and infections.

In October, patient experience intelligence firm Press Ganey released survey data outlining safety event increases across adult critical care, medical, step-down, high quality, moderate acuity, surgical and med-surg units. In particular, patient falls and CLABSIs saw major jumps across certain units upon the onset of the pandemic.

These warnings came about a month after the Centers for Disease Control and Prevention outlined a near across-the-board increase in healthcare-associated infections through 2020, as well as a 47% year-over-year increase in CLABSIs.