Results of the 2013 Leapfrog
Hospital Survey
Developed for The Leapfrog Group by Castlight Heath
www.LeapfrogGroup.org/HospitalSurveyReport
Rate of hospital participation in the 2013 Leapfrog Hospital Survey by state
Responses submitted as of December 31, 2013
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
The Leapfrog standard for CPOE is aimed at ensuring that patients are being
prescribed medications through a computerized order entry system that alerts
prescribers to drug-drug interactions, drug-allergy interactions, and other potential
prescribing errors
Hospitals Meeting Leapfrog's Computerized Physician Order Entry (CPOE)
Standard
National Percentage of Hospitals
43%
31%
18%
14%
10%
2009
2010
2011
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2012
2013
The Leapfrog standard for CPOE is aimed at ensuring that patients are being
prescribed medications through a computerized order entry system that alerts
prescribers to drug-drug interactions, drug-allergy interactions, and other potential
prescribing errors
CPOE Test Orders That Did Not Receive an Appropriate
Warning
Percentage of Orders
52%
37%
36%
36%
% of all tested orders that did not prompt
appropriate warnings from hospital CPOE
systems
32.8%
14.2%
13%
2008-2010
2011
2012
12.5%
% of the tested orders that would have
caused patient death, that did not prompt
appropriate response from hosptial CPOE
systems
2013
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
Early elective deliveries are scheduled cesarean sections or medical inductions
performed prior to 39 completed weeks of gestation without medical necessity, which
carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of
early elective deliveries before 39 weeks is less than or equal to 5%.
Average Rate of Early Elective Deliveries as reported to the Leapfrog
Hospital Survey
17%
Rate of Early Elective Deliveries
14%
11.2%
4.6%
2010
2011
2012
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2013
Early elective deliveries are scheduled cesarean sections or medical inductions
performed prior to 39 completed weeks of gestation without medical necessity, which
carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of
early elective deliveries before 39 weeks is less than or equal to 5%.
% Hospitals Achieving ≤5% Early Elective Deliveries as reported to
the Leapfrog Hospital Survey
% Hospitals with <5% EED
71%
46%
39%
30%
2010
2011
2012
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2013
Early elective deliveries are scheduled cesarean sections or medical inductions
performed prior to 39 completed weeks of gestation without medical necessity, which
carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of
early elective deliveries before 39 weeks is less than or equal to 5%.
Early Elective Deliveries as reported to the Leapfrog Hospital Survey,
2010 to 2013
2010
2013
Leapfrog standard
35%
Elective Delivery Rate
30%
25%
20%
15%
10%
5%
0%
MA MN ME SC WA CA NY
LA
AZ
MI OR
FL
NJ
PA NC CO
IL
VA TN GA MS TX
State
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
WI NV
IN WY OH UT
An episiotomy is an incision made in the perineum (the birth canal) during childbirth.
Although an episiotomy was once routine in childbirth, medical guidelines today
recommend episiotomy only in a narrow set of cases. Leapfrog’s standard is that the
hospital’s rate of episiotomy is less than or equal to 12%
2013 Episiotomy Rate as reported to the Leapfrog Hospital Survey
Leapfrog standard
Number of Hospitals
348
257
226
114
38
18
0-5%
5.1-12%
12.1-20%
20.1-30%
Episiotomy Rate
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
30.1-40%
>40%
Leapfrog’s standard for High-Risk Deliveries is that the hospital delivers at least 50
very-low birth weight babies per year and ensures that at least 80% of mothers
receive antenatal steroids prior to delivery OR the hospital has a lower than average
morbidity/mortality rate for very-low birth weight babies.
Number of Hospitals Meeting Leapfrog’s Standard for HighRisk Deliveries
Meets Standard
Does Not Meet Standard
Number Meeting Standard
343
249
224
134
128
108
2011
2012
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2013
Leapfrog predicts survival rates for high-risk procedures using two pieces of
information: the number of patients who had the surgery at a particular hospital and
the number of patients who died from having the procedure at that hospital. The
survival rate predictors were developed by Drs. John Birkmeyer and Justin Dimick
2013 High-Risk Procedure Predicted Mortality Rates as reported to the
Leapfrog Hospital Survey
Lowest Predicted Death Rate
Highest Predicted Death Rate
Average Predicted Death Rate
3.1%
4.8%
7.4%
Aortic Valve
Replacement
Abdominal
Aortic Aneurism
0.9%
3.1%
0%
6.9%
20.9%
9.3%
Pancreatectomy
2.5%
9.4%
12%
Esophagectomy
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
Hospital-acquired pressure ulcers at stage III and IV are “bedsores” that are caused by
remaining in one position for a long time and can be prevented through known
precautions. Stage III and IV pressure ulcers are very deep, serious sores that may reach
muscle or bone. Leapfrog’s standard is that the rate of stage III and IV pressure ulcers is
zero.
2013 Stage III & IV Hospital-Acquired Pressure Ulcer Rates
692
Number of Hospitals
597
0
0.1-1
15
3
1.1-2
2.1+
Pressure Ulcers Per 1000 Inpatient Discharges
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
Hospital-acquired injuries are falls and other traumatic injuries (broken or dislocated
bones, crushing injuries, or burns) that occur while a patient is in the hospital. Although
some falls and injuries may occur when hospitals are providing quality care, many
others can be avoided. Leapfrog’s standard is that a hospital’s rate of falls & injuries is
close to zero
2013 Hospital-Acquired Injury Rates
Number of Hospitals
939
232
96
0
0.1-1
1.1-2
Injuries Per 1000 Inpatient Discharges
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
34
6
2.1-5
5.1+
Leapfrog uses a standardized infection ratio (SIR) to aggregate a hospital’s performance
on Central-Line Associated Bloodstream Infections across multiple ICU types and to
standardize the reporting out of a hospital’s performance. The SIR is a ratio of a
hospital’s actual number of infections over an expected number of infections.
Standardized Infection Ratios for Central Line- Associated Blood
Stream Infections as reported to the Leapfrog Hospital Survey
2011
67.9%
2013
65.8%
% Of Hospitals
64.4%
2012
18.1%
18.8%
16.8%
15.0%
11.8%
13.5%
3.7%
0
0.1-1
1.1-2
Standardized Infection Ratio (lower is better)
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2.2%
2+
1.9%
Leapfrog uses a standardized infection ratio (SIR) to aggregate a hospital’s
performance on Catheter-Associated Urinary Tract Infections across multiple ICU types
and to standardize the reporting out of a hospital’s performance. The SIR is a ratio of a
hospital’s actual number of infections over an expected number of infections. 2013
was the first year that Leapfrog included this measure on the survey.
2013 Standardized Infection Ratios for Catheter-Associated
Urinary Tract Infections as reported to the Leapfrog Hospital
Survey
% Of Hospitals
71.8%
17.4%
10.2%
0.6%
0
0.1-1
1.1-2
Standardized Infection Ratio (lower is better)
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2+
Hospital-acquired Conditions (HACs) are medical conditions or complications that
were not present when a patient was admitted to the hospital, but developed as a
result of errors or accidents in the hospital. Hospitals can prevent many of these
conditions; some hospitals have zero or close to zero reported HACs.
Overall hospital performance on hospital-acquired conditions on
the Leapfrog Hospital Survey, 2013
454
Number of hospitals
342
145
28
13
0
1
2
3
4
Number of hospital-acquired condition categories (CLABSI, CAUTI, Hospital-acquired pressure ulcers, Hospitalacquired injuries) with zero incidents
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
Research has shown that hospitals staffing their ICUs with physicians who are certified
in critical care medicine (intensivists) can reduce ICU mortality by as much as 40%.
Leapfrog’s standard asks that patients in adult or pediatric medical and/or surgical or
neuro ICUs are being cared for by intensivists. These intensivists are present at least 8
hours a day, 7 days per week. When not present in the ICU, the intensivist responds to
pages within 5 minutes or has another physician, physician assistant, nurse
practitioner, or trained nurse that does reach the patient within 5 minutes.
% Hospitals Meeting Standard
Percent of Hospitals Meeting Leapfrog’s ICU Physician Staffing
Standard
41.7%
39.0%
35.1%
2011
2012
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2013
Leapfrog’s standard asks that the hospital has a policy in place so that if a Never Event
occurs, the hospital will (a) apologize to the patient and/or family (b) report the event
to an outside agency (c) perform root-cause analysis (d) waive costs directly related to
the Never Event and (e) make a copy of the policy available to patients and payers
Number of Hospitals Meeting Leapfrog’s Never Events Policy
Standard
Meets Standard
Does Not Meet Standard
1119
941
857
Number of Hospitals
831
387
864
343
283
2009
2010
2011
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
244
2012
292
2013
Leapfrog asks hospitals to report on their implementation of eight National
Quality Forum-endorsed Safe Practices that, if adopted, can improve patient
safety in healthcare settings.
% of Hospitals With Perfect Compliance with Leapfrog Safe
Practices by Practice, 2013
% Hospitals With Perfect Compliance
70%
69%
56%
62%
59%
59%
52%
45%
Leadership
Structures
Culture
Measurement
Training in
Teamwork
Risk
Identification
Nursing
Workforce
Medication
Mgmt
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
Hand Hygiene
Ventilators
Not having enough nurses and the lack of quality nurse education can expose patients
to greater risk. Short staffing in particular has been linked to increased mortality,
complications, adverse events, longer hospital stays, and greater resource usage.
Leapfrog believes the public deserves to know about hospitals with strong nursing
workforces, as this leads directly to increased safety and quality.
Nursing Workforce Best Practices Requirements Met on the 2013
Leapfrog Hospital Survey
Met all requirements
82.2%
79.9%
Number of Hospitals
68.2%
51.0%
Awareness
Accountability
Ability
Area of Hospital Safety
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
Action
Leapfrog is the only ratings provider that tracks and rewards Magnet® Status, an elite
designation for nursing excellence, and gives credit to hospitals with this designation
as fully meeting Leapfrog’s standard. Developed by the American Nurses Credentialing
Center (ANCC), Magnet is the leading source of successful nursing practices and
strategies worldwide.
Hospitals Reporting Magnet Status Designation to the Leapfrog
Hospital Survey
221
181
Numer of Hospitals
163
2011
2012
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2013
Many healthcare-associated infections (HAIs) are caused by pathogens transmitted
from one patient to another via the contaminated hands of healthcare workers. The
CDC estimates that approximately 2 million patients annually acquire an HAI, and
nearly 90,000 patients die as a result. Hand hygiene is one of the most important and
effective means to stop the spread of pathogens in healthcare facilities.
Hand Hygiene Safe Practice Score (Max 30)
Hand Hygiene Average Compliance on Leapfrog’s Safe Practice
Urban
28
Rural
27.6
27.5
27
27
26
25.5
25
24.2
23.9
24
23
22
2011
2012
Year
SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)
2013