Hospital quality not up to par

May 15, 2009

CPOE has received attention to reduce medication errors and adverse drug reactions, but adoption has been slow, according to data from the 2008 Leapfrog Hospital Survey.

According to the 2008 Leapfrog Hospital Survey, only 7% of hospitals fully meet Leapfrog medication error prevention standards and low percentages of hospitals are fully meeting mortality standards.

“The data from 2008 are mostly disappointing, not in ways that surprise managed care, but in ways that surprise the public,” says Leapfrog CEO Leah Binder.In the last 15 years, the problem of medication errors and adverse drug events, and implementing computerized physician order entry (CPOE) as part of the solution have received heightened attention, though progress with CPOE has been slow, says Binder.

“Although the 7% is a bit of an improvement, we’d like to see greater adoption of CPOE,” she says.Leapfrog’s CPOE standard includes having hospitals enter at least 75% of their inpatient medication orders through their CPOE system and having hospitals assess the implementation of their CPOE system with the Leapfrog CPOE Evaluation Tool to ensure their CPOE system is alerting prescribers to common, serious prescribing errors.

Although Leapfrog did not release individual hospital scores from the tool, hospitals that systems generally did not perform well on the CPOE test were sent an advisory.

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

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

More than 3,000 deaths could be avoided each year if Leapfrog standards were implemented in all hospitals that electively perform the above procedures.

The Leapfrog safe practices score was “shockingly” low, according to Binder. The safe practices score summarizes a hospital’s adherence to 13 safety practices endorsed by the National Quality Forum, such as maintaining a culture of safety, hand washing, nursing coverage and prevention of infections.

“We found 32% of hospitals fully meet at least 90% of the recommended procedures and policies,” Binder says. “That needs to be addressed as part of what managed care executives discuss with hospitals and employer clients.”There is a bright spot in that 31% of hospitals fully meet the Leapfrog standard for ICU physician staffing and another 7% plan to do so by the end of this year.

“There needs to be a board-certified intensivist managing patients in the ICU. Evidence shows they reduce mortality by 40%,” Binder says. “We have to encourage physicians to become intensivists.”