What are the results of the 2013 Leapfrog Hospital Survey?

Hospital survey

On July 18, 2014 the Leapfrog Group released the results of its 2013 Hospital Survey, detailing vast improvement in several areas, such as computerized physician order entry (CPOE), maternity care, compliance with ICU physician staffing standards, and others. The survey itself has been the most successful edition so far, setting a record for participation. More than 1,400 hospitals submitted to the poll; that is, 37% of all hospitals in the United States. The scrutiny focused on seven major areas, to wit:

1.       Medication errors

2.       Maternity care

3.       High-risk surgeries

4.       Hospital -acquired conditions: Infections in intensive care units (ICUs), pressure ulcers, and injuries

5.       ICU physician staffing

6.       Serious adverse events (including ‘never events’)

7.       Safe practices

Medication errors are the main source of hospital mistakes with an average of one a day per inpatient stay. A well designed CPOE system can significantly decrease these errors, as indicated by Chief of General Medicine at Boston’s Brigham and Women’s Hospital Dr. David Bates, and others. The leapfrog Group has not only tracked CPOE adoption since 2001 but has come up with two distinct standards for use, namely:

·         A minimum of 75% of medication orders across all inpatient units must be ordered through a CPOE system, and

·         Hospitals must continually test the safety of their CPOE systems with the Evaluation Tool designed by Drs. David Bates and David Classen.

The survey found that a record-setting number of 616 hospitals (43%) have adopted CPOE systems as well as complied with Leapfrog’s standards for their use, up from 113 in 2009. This increase reflects the impact of federal funding for meaningful use of health information technology. There is still room for improvement, though. For example, not all medication orders that were tested during simulation offered proper warnings for the test orders that would have resulted in patient harm.

Maternity care. According to Leapfrog, a hospital’s scheduled rate of cesarean sections and elective inductions before 39 weeks should be 5% or lower. The average national rate of early elective delivery dropped from 17% in 2010 to 4.6% in 2013. Early elective deliveries before 39 full weeks of gestation can lead to neonatal intensive care unit admissions, prolonged length of stay, and higher costs. Organizations like the American College of Obstetrics and Gynecology and the March of Dimes have recommended and campaigned for the cessation of these procedures. Unfortunately, more than 130 hospitals report a rate of more than 10%, and 17 report a rate of 30% or higher.

High-risk surgeries. The Leapfrog Group had University of Michigan’s Drs. John Birkmeyer and Justin Dimick predict the survival rate of four high-surgeries based on the amount of patients who had surgery at a given hospital and the amount of patients who didn’t survive the surgery at that particular facility, as reported by the polled hospitals.


Predicted death rate





Aortic valve replacement




Abdominal aortic aneurism













Hospital-acquired conditions refer to medical issues that appear only after a patient has been admitted to a hospital, and which stem from errors or accidents within the facility. The four major such conditions evaluated by the survey are:

·         Stage III and IV pressure ulcers. Very deep and painful bedsores caused by prolonged bed or wheelchair use without changing position. Can cause infection and even amputation. Leapfrog standard: Zero. Close to 700 hospitals (52.9%) reported zero pressure ulcers, 597 reported 0.1-1, 15 reported 1.1-2, and 3 reported 2.1+.

·         Falls and injuries such as broken or dislocated bones, crushing injuries, or burns. Leapfrog standard: Close to zero. 232 hospitals reported zero injuries, 939 reported 0.1-1, 96 reported 1.1-2, 34 reported 2.1-5, and 6 reported 5.1+.

·         Central line-associated bloodstream infections (CLABSISs) cause by germs entering the body via catheters or tubes. Deadly and costly but can be prevented with safe insertion methods. Leapfrog standard: Zero. 18.8% of hospitals reported zero CLABSIs, 65.8% reported 0.1-1, 13.5% reported 1.1-2, and 1.9% reported 2+.

·         Catheter-associated urinary tract infections (CAUTIs). Leapfrog standard: Close to zero. 17.4% of hospitals reported zero CAUTIs, 71.8% reported 0.1-1, 10.2% reported 1.1-2, and 0.6% reported 2+.

                ICU physician staffing. Most hospitals average 10% to 20% death rates for patients admitted to intensive care units, and patient deaths in U.S. ICUs exceed 200,000 casualties every year. Employing doctors who specialize in critical care medicine 8hrs/day, 7 days/week -as per Leapfrog standards- can decrease ICU mortality by up to 40%. The 2013 survey showed that 41.7% of responding hospitals fully comply with this ICU physician coverage standard, representing a 3% increase from the previous year.

Never events. Catastrophic but preventable errors that should never occur but nevertheless do, such as surgery on the wrong part of the body. Almost 1120 (79%) of hospitals meet Leapfrog’s standards of:

·         Apologizing to the patient and or/family

·         Reporting the event to an outside agency

·         Performing root-cause analysis

·         Waiving costs directly related

·         Making copies of the policy available to patients

should a never event ever happen.

Safe practices include

1.       Leadership structures and systems

2.       Measurement culture

3.       Teamwork training and skill building

4.       Mitigation of risks and hazards

5.       Nursing workforce

6.       Hand hygiene

7.       Proper interventions for ventilated patients

According to the results, 56.5% of urban hospitals comply with these practices, as opposed to 37% of rural hospitals.

Though Leapfrog was launched in 2000, it is now with the implementation of the Affordable Care Act that this yearly survey takes on even more importance that it has ever had. Fortunately, the number of hospitals that take part in the poll continues to increase, meaning that the bid for transparency has been welcomed by a medical care field that strives to improve itself.  

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