The Leapfrog Group, sponsored by The Business Roundtable with support from the National Health Care Purchasing Institute, unveiled in January the results of a months-long survey aimed at determining how seriously urban acute-care facilities take the problem of medical errors.
The survey tallied responses from regions of the country specifically targeted by Leapfrog. While 472 facilities were invited to participate in the survey, 254 declined. The 228 facilities responding to the survey included urban hospitals in California, Minnesota, and eastern Tennessee, as well as facilities in Atlanta and St. Louis.
Leapfrog plans to offer the survey to an additional 1,000 hospitals this year. Any hospital can volunteer to join the study.
Survey Design
The participating facilities are invited to complete a Web-based survey and share information with their communities about efforts to reduce preventable medical mistakes.
Survey respondents are asked about their efforts to comply with three patient safety standards considered key by Leapfrog: computer physician order entry, intensive care unit (ICU) physician staffing, and evidence-based hospital referral.
The three principles were developed through an extensive literature review and with input from subject matter experts and health care quality researchers, in partnership with large national purchasers of health care. The group’s early research indicated meeting those standards could save more than 58,300 lives and prevent more than 500,000 serious medication errors each year.
Survey Findings
- Only 3.3 percent of hospitals participating in the survey currently meet Leapfrog’s standards for computerized prescription order entry. Such systems require physicians to enter a prescription order into a computer using software designed to spot such potential problems as dangerous drug interactions and patient intolerance to the drug. Leapfrog contends employment of such systems could prevent over 500,000 medication errors a year. About 30 percent of the hospitals responding to the survey said they plan to have such systems in place by 2004.
- 10 percent of hospitals surveyed have fully implemented the practice of staffing intensive care units with “intensivists,” specialists in this form of care. The Leapfrog Group says at least one in ten patients who die every year in ICUs would have an increased chance to survive if ICU specialists were on hand to manage patient care. About 18 percent of hospitals responding to the survey plan to enlist specialists by 2004.
While the initial findings were discouraging, other responses indicated hospitals were preparing to take steps to reduce preventable medical mistakes, said Suzanne Delbanco, executive director of The Leapfrog Group.
Not Convinced
Several hospital industry associations and individual hospital representatives provided input into the survey design. But in a news release commenting on the survey, the American Hospital Association (AHA), a Washington-based trade group, said it is concerned the approach oversimplifies the complex task of improving quality and seems to suggest a one-size-fits-all solution will work for every hospital in any kind of community.
In the case of computerized physician order entry, for example, AHA notes “this is a promising new technology; however, there isn’t an off-the-shelf system for hospitals to buy today. Custom designing such systems is costly and takes time.”
High cost is most often cited by facilities that fail to employ technological innovations. Tight-fisted cost controls practiced by managed care firms, along with reimbursement cuts by federal government health programs, have made dollars scarce.
Carmela Coyle, senior vice president for policy at the AHA, said she worries consumers will draw the wrong conclusions from the Leapfrog survey. “The absence of a hospital engaging in the three initiatives doesn’t mean a hospital is of lower quality,” she noted.
Experience Counts
In addition to encouraging provider facilities to meet its three patient safety standards, The Leapfrog Group also aims to change behaviors in patients themselves.
For example, it encourages patients with complicated medical conditions to seek out hospitals with experience and demonstrated positive patient outcomes. According to Leapfrog, facilities that perform certain procedures often are more likely to perform them better than facilities that only rarely perform complicated procedures.
Patients needing coronary artery bypass surgery, for example, are encouraged by Leapfrog to have that procedure at a hospital performing the operation at least 500 times a year. About 12 percent of the hospitals surveyed have that level of experience in bypass surgery.
The Leapfrog survey found consumers in most urban areas have a choice of hospitals with extensive experience treating patients needing certain high-risk surgeries or neonatal intensive care.
Comprised of more than 90 public and private organizations providing health care and representing approximately 28 million health care consumers in all 50 states, The Leapfrog Group provides information and solutions for consumers and health care providers. Its efforts focus primarily on the quality of certain aspects of care relevant to urban area hospitals.
For more information …
on the Hospital Patient Safety Survey, visit the Leapfrog Group Web site at www.leapfroggroup.org.
