Most hospitals fail to meet quality standards, including heart guidelines

U.S. hospitals have failed to adequately protect patient safety and too many hospitals have failed to implement standards known to improve quality and save lives, according to the 2008 Leapfrog hospital survey.

Only 7 percent of hospitals fully meet computerized physician order entry (CPOE) standards and a low percentage of hospitals are fully meeting mortality standards. Among surveyed hospitals, efficiency standards--defined as highest quality and lowest resource use--are met by only 24 percent of hospitals for heart bypass surgery, 21 percent for heart angioplasty, 14 percent for heart attack care and 14 percent for pneumonia care.

Relatively low percentages of reporting hospitals are fully meeting volume- and risk-adjusted mortality standards, or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives:

• 43 percent for heart bypass surgery;
• 35 percent for heart angioplasty;
• 32 percent for high-risk deliveries;
• 23 percent for pancreatic resection;
• 16 percent for bariatric surgery;
• 15 percent for esophagectomy;
• 7 percent for aortic valve replacement; and
• 5 percent for aortic abdominal aneurysm repair.

Other highlights of the 2008 hospital survey include:

• 65 percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs);
• 75 percent do not fully meet the standards for 13 evidence-based safety practices, ranging from hand washing to competency of the nursing staff.
• Only 26 percent and 34 percent of reporting hospitals are fully meeting standards for treating two common acute conditions, acute heart attacks and pneumonia, respectively.
• Only 30 percent and 25 percent of hospitals are fully meeting standards to prevent hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.
• 31 percent of hospitals now meet the ICU staffing standard, up from just 10 percent in 2002.
• Hospitals with all of recommended policies in place to prevent common HAIs jumped from just 13 to 35 percent between 2007 and 2008.
• 60 percent of hospitals have agreed to implement a "never events" policy when a serious reportable event occurs within their facility.

"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," said Leah Binder, CEO of Leapfrog. "According to our data, a majority of hospitals have significant safety and efficiency deficits."

Binder added that few hospitals are meeting Leapfrog's newly established efficiency measure standards--the first such data available in the public domain. However, many hospitals are demonstrating demonstrating quality excellence and serving as role models.

"We need to take the lessons learned from the best hospitals and use these to move the status quo forward so all Americans have access to safe, cost-effective care," Binder said.

She added that there were "notable improvements" within hospitals surveyed in 2008 but said that "progress on patient safety is moving too slowly."

"Consumers and purchasers of healthcare want hospitals to implement safety standards and procedures known to improve quality and reduce unnecessary injury and death," she concluded.

The voluntary Leapfrog Hospital Survey results are as of Dec. 31, 2008, and include 1,276 hospitals in 37 major U.S. metropolitan areas, representing 48 percent of the urban, general acute-care hospitals (53 percent of hospital beds in these areas).