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Are You Leaping Yet???

July 6, 2009
by Mark Hagland
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In putting out its most recent national survey on hospital quality this spring, the Leapfrog Group summarized things pretty neatly in the first sentence of its accompanying press release: “Though it has been 10 years since the Institute of Medicine’s landmark report on the failure of U.S. hospitals to adequately protect patient safety, too many hospitals still have failed to implement standards known to improve quality and save lives.”

The organization, which includes a virtual Who’s Who of many of the largest employer-purchasers in the U.S., found largely disappointing results from its 2008 Leapfrog Hospital Survey, which measured quality and IT developments as of December 31 of last year, encompassing 1,276 hospitals (which in turn represented 48 percent of the urban, general acute-care hospitals in the country).

Among the disappointing highlights included:

Ø Only 7 percent of surveyed hospitals met Leapfrog’s CPOE implementation/medication error prevention standards;

Ø Only 26 percent of reporting hospitals are fully meeting standards for treating heart attacks, and only 34 percent are fully meeting standards for treating pneumonia;

Ø Only 35 percent are have put in place the group’s full slate of recommended policies to prevent hospital-acquired infections (HAIs);

Ø Only 30 percent are fully meeting the group’s standards to prevent hospital-acquired pressure ulcers.

I have to say that I find these results rather dispiriting. Only 30 percent of hospitals reporting into Leapfrog (which means the broader nationwide level must perforce be even lower) are following standard practices to prevent bedsores?? This is so basic—and so long-understood—a problem that it’s hard to imagine that outside groups like Leapfrog still have to bang the drums to pressure hospitals to tackle it.

In fairness, the Leapfrog report of a few months ago did note a few areas of broad improvement, including these:

Ø Thirty-one percent of hospitals now meet the Leapfrog ICU staffing standard, up from just 10 percent in 2002;

Ø The percentage of hospitals that have implemented all of Leapfrog’s recommended policies to prevent common HAIs jumped from 13 percent to 35 percent between 2007 and 2008;

Ø In addition, 60 percent of hospitals participating in the Leapfrog survey have agreed to implement the group’s “never events” policy when a serious reportable event occurs within their organization.

What is of particular interest to me is the strong and explicit linkage the Leapfrog folks have made and continue to make between certain types of patient safety data and clinical IS development. For example, Leapfrog has for several years been beating the drum for CPOE implementation, linking it tightly and correctly to medication error reduction, though with very mixed results. Indeed, from 2002, when the organization first surveyed on CPOE implementation, the level of implementation has gone from 2 percent to 7 percent—in six years. Now, it must be noted that Leapfrog’s standard includes that a hospital must enter at least 75 of its inpatient medication orders through its CPOE system, and its leaders must use the Leapfrog CPOE Evaluation Tool “to ensure their CPOE system is alerting prescribers to common, serious prescribing errors.”

A bit more happily, 49 percent of Leapfrog Survey-participating hospitals have made “some progress” on CPOE implementation. Still, everyone knows that CPOE implementation is difficult and complex, and these results, while not exactly anything to cheer about, at least show some progress forward.

What’s more, the fact that external payer groups like Leapfrog continue to try to press hospital organizations forward in all these areas is, I think, very good and very important, since it’s absolutely clear, for example, that good CPOE implementation is absolutely crucial to the effort to bring down the current rate of medication errors in hospitals.

And as hard as it is to effect significant and truly meaningful change in hospital patient safety, this is an area that continues to cry out for real change. Patients deserve—and employer-purchasers, payers, and policymakers are right to insist on—better patient safety performance from hospital organizations nationwide. And as long as hospitals aren’t leaping forward dramatically year over year in documented improvements in patient safety and care quality, there will necessarily be a place for Leapfrog and all the other external groups to keep hospital organizations focused on the bigger picture. For CIOs, the most recent Leapfrog report could prove to be one of a number of great tools to use in arguing now to push forward quickly in the clinical IS investments that, pursued intelligently and planfully, could win our industry plaudits from purchasers and payers—and, even more importantly, improve the care and outcomes of our patients. The question is: are you leaping with Leapfrog yet?

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Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...