New Leapfrog Hospital Safety Grades Find Improved Infection Rates

By Jay Kumar

Hospitals have improved how well they prevent healthcare-associated infections (HAI), according to The Leapfrog Group’s fall 2023 Hospital Safety Grades.

The Safety Grades assign a letter grade to nearly 3,000 general hospitals on how well they prevent medical errors, accidents, and infections. The latest grades show hospitals reducing HAIs post-pandemic, after significant increases in infection rates during the COVID-19 pandemic. This cycle, nearly 30% of hospitals earned an “A,” 24% earned a “B,” 39% earned a “C,” 7% earned a “D,” and less than 1% earned an “F.”

Utah is the state with the highest percentage of “A” hospitals in the country this fall. After Utah, the top states 10 for “A” hospitals are: Virginia, North Carolina, Pennsylvania, South Carolina, Connecticut,

Montana, Tennessee, Florida, and Texas. States with the least favorable performance are Vermont, Wyoming, Delaware, Washington, DC, and North Dakota, where no hospitals earned an “A.”

“What we’ve seen is significant improvements in many of those HAIs since the peak we saw in the fall 2022 Safety Grades,” says Katie Burgraff Stewart, director of Health Care Ratings, The Leapfrog Group.

There was a 19% decrease in central line-associated bloodstream infections (CLABSI), an 18% decrease in catheter-associated urinary tract infections (CAUTI), and a 19% decrease in Methicillin-resistant Staphylococcus aureus (MRSA). CAUTI is the only one back to pre-pandemic infection levels. The others are still elevated over the pre-pandemic infection rates, says Stewart. All three infections had reached a five-year high during the pandemic.

The latest data shows that over 85% of hospitals have improved performance on at least one of the three dangerous infections the Hospital Safety Grade accounts for. That includes:

• 19% of hospitals have improved in all three infection measures,
• 66% of hospitals have improved at least one infection measure, and
• 16% of hospitals have continued to worsen or made no improvement.

Declines in patient experience scores

The Leapfrog Hospital Safety Grade also includes five patient experience measures that evidence suggests are closely associated with patient safety issues. The scores for the measures are calculated using patient responses to a national and standardized patient survey following a hospital visit. Patients are asked to rate their experience of nurse communication, doctor communication, staff responsiveness,

communication about medicine, and discharge information. Nationally, patient experience scores worsened for the second year in a row, and all states experienced a significant decline in reported patient experience from the fall 2021 to the fall 2023 Safety Grade.

“We did see worsening performance on patient experience, which is particularly troubling,” Stewart says. “We’re seeing it at the national level and also at the state level.”

Patient experience reports show the most significant declines in the categories of “communication about medicines” and “responsiveness of hospital staff,” both of which correlate with preventable medical errors according to recent studies, according to Leapfrog.

The patient experience declines are attributed to several factors. Stewart says Leapfrog talked to hospital and health system leaders and heard that staff burnout that began during the pandemic is one contributor. Staffing shortages are another contributor, as the staff turnover rate has remained high at some facilities.

Another factor is differences in training. The pandemic forced organizations to conduct training remotely and, in some cases, COVID-19 precautionary measures are still in use, limiting patient interactions, she says.

One way to turn these scores around is through transparency, Stewart says.

“Consumers are not only using this information to choose where to go to get care, but hospitals use it for quality improvement purposes,” she notes. “More work needs to be done with these contributing factors.”

“While we’re seeing worsening performance at the national and state levels, there are individual hospitals that are doing good work in patient experience,” Stewart adds.

“Some hospitals may not have been as resilient to the factors brought on by the pandemic,” she says. “There’s an opportunity for shared learning there.”

The Leapfrog Hospital Safety Grade is the only hospital ratings program based exclusively on hospital prevention of medical errors and harms to patients. It is fully transparent and free to the public, and grades are updated biannually in the fall and in the spring. For more information about the Hospital Safety Grade, including details on individual hospital grades and state rankings, please visit HospitalSafetyGrade.org.