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Study: Implementation Slow for Patient Safety Standards

By Melissa Attias, CQ Staff

April 21, 2009 -- Many hospitals have not implemented standards that would improve the quality of patient care and save lives, according to the 2008 Leapfrog Hospital Survey.

"Progress on patient safety is moving too slowly," said Leapfrog CEO Leah Binder in a news release. "Consumers and purchasers of health care want hospitals to implement safety standards and procedures known to improve quality and reduce unnecessary injury and death."

The survey was voluntarily completed by 1,282 acute care hospitals in 44 states.

According to the report, only 7 percent of hospitals fully met Leapfrog's medication error prevention standard that requires hospitals to enter 75 percent of inpatient medication orders through a Computerized Prescriber Order-Entry (CPOE) system and use a Leapfrog evaluation tool to test the system. With CPOE, physicians enter medication orders into a computer rather than on paper so that they can be integrated with patient information and automatically checked for potential problems or errors. These systems can reduce the number of adverse drug events by up to 88 percent, according to the Leapfrog report.

The report also shows that 65 percent of hospitals do not have all the recommended policies in place to prevent common hospital-acquired infections, which affect two million patients in American hospitals each year. Of those two million, Leapfrog says 90,000 of them die from the infection acquired during care, which is almost twice the amount of deaths caused by breast cancer and AIDS combined. At the same time, only 30 percent and 25 percent of hospitals are fully meeting standards to avoid hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.

In addition, the report says that efficiency standards were only met by 24 percent of hospitals for heart bypass surgery, 21 percent for heart angioplasty, and 14 percent for both heart attacks and pneumonia. Twenty-six percent of hospitals fully met quality standards for treating heart attacks, the report says, while 34 percent met standards for treating another common acute condition, pneumonia. The report also shows that 32 percent of hospitals adhere to at least 90 percent of safety practices endorsed by the National Quality Forum, from competency of nursing staff to hand washing.

Nevertheless, the survey showed hospitals have improved in some areas of patient care. Thirty-one percent of hospitals met the Leapfrog Intensive Care Unit staffing standard according to the 2008 report, for example, compared with just 10 percent in 2002. The standard requires that intensivists (physicians trained in critical medical care) manage "general medical, surgical and neuro ICUs for at least seven days a week, eight hours per day, with additional availably by pager within five minutes," according to the report. Leapfrog says that standard could avoid more than 54,000 deaths and up to $4.3 billion in costs each year.

In addition, though only 35 percent of hospitals have all the recommended policies in place to prevent hospital-acquired infections, that number is up from just 13 percent in the 2007 survey. The report also says that 60 percent of hospitals have agreed to implement Leapfrog's "Never Events" policy to prevent hospitals from repeating serious medical errors.

Yet a recent report in the New England Journal of Medicine shows that the majority of hospitals in the United States have not adopted electronic health records, despite majority consensus the technology will contribute to more efficient, safer and higher-quality care.

The study surveyed all acute care hospitals with membership in the American Hospital Association and received responses from 63.1 percent of those surveyed. Based on these responses, only 1.5 percent of hospitals in the United States have a comprehensive electronic medical records system implemented across all major clinical units. Less than 8 percent have a basic system in place that included "functionalities for physicians notes and nursing assessments in at least one clinical unit," the report said.

The study also showed that larger institutions, major teaching hospitals, and hospitals part of larger hospital systems or located in urban areas were more likely to have electronic records systems. Among those hospitals that did not have electronic systems, 74 percent cited inadequate capital as barrier to purchase. Other barriers hospitals cited included concerns about maintenance costs (44 percent), resistance from physicians (36 percent), unclear return on investment (32 percent) and lack of availability of staff with sufficient expertise in information technology (30 percent), the report said.

To encourage more hospitals to adopt electronic-records systems, researchers recommended financially rewarding hospitals that use health information technology. Researchers also said a policy strategy should focus on interoperability of electronic systems and training technical support staff.

"Modernizing health care systems with electronic health records is a critical piece of any health reform effort," said John Lumpkin, senior vice president of the Health Care Group at the Robert Wood Johnson Foundation, in a news release. "While the adopted rates are discouraging, this report helps us understand the key barriers we need to overcome to achieve higher rates of HIT adoption and better health and health care for all Americans."

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