On behalf of patients, purchasers, and the public, the Leapfrog Group is a leading voice for safer, higher quality, and more transparent health care. The impetus for its formation was the Institute for Medicine’s urgent call to action and report, To Err is Human. Published in the American Journal of Medicine in 1999, it made it perfectly and publicly clear: medical mistakes are a top cause of preventable harm and death in the United States.

Leapfrog's advocacy started with a simple three-question survey of hospitals. If implemented, each recommendation represented a potential giant leap forward for patient safety. So straightforward and obviously important from today’s lens, it’s hard to understand the pushback that was initially received, with hospitals discrediting the “science” and boycotting the survey. Leapfrog knew all too well that what is was asking was expensive and that the technology was not perfect. Yet, it also understood that the technology would not get better until it was used and that the cost of not acting was both expensive and harmful.  

Leapfrog's first three leaps are still included in its annual, voluntary hospital questionnaire. With results available publicly online, patients, purchasers, and providers can all ask if their hospital has:

(1) Computerized Physician Order Entry (CPOE)
With federal financial support, more than 95% of hospitals have implemented Electronic Health Records (EHRs). Few would consider going back to the old ways of handwritten orders. One report suggests that medical errors have decreased 52% as a result of online ordering, and three times as many physicians reported that their EHR prevented a potential medication error rather than cause one. Yet, there is more to be done. A November 2021 report finds that 7,000 to 9,000 Americans die due to a medication error each year. The total cost of looking after patients with medication-associated errors exceeds $40 billion each year, with over seven million patients affected. 

(2) ICUs staffed with intensivist physicians during daytime hours (can be partially met with telemedicine)
The benefit of having patients cared for by physicians trained in critical care has been well-researched and found to reduce ICU mortality and spending. A recent study published in the Journal of Thoracic and Cardiovascular Surgery found that 24-hour intensivist coverage was associated with lower mortality, lower rates of cardiac arrest, and shorter durations of mechanical ventilation. Interestingly, the practice of a trained intensivist physician assuming responsibility for ICU patients' care has been the mainstay in Europe for decades. According to a 2016 report, only about half of hospitals in the US meet this criteria, and practices vary widely by state.   

(3) Enough surgical volume to safely perform certain high-risk procedures
Unknowingly, patients are often at greater risk of death and complications because their surgical teams do too few procedures (even common ones) for doctors, nurses, and technicians to maintain their skills. For 10 high-risk surgeries, Leapfrog asks hospitals to report their case volumes annually. In 2015, knowing that patients in the hands of low-volume surgeons or hospitals tend to fare worse, a group of leading academic institutions asked all hospitals to “Take the Volume Pledge” to improve surgical outcomes. Johns Hopkins, a leader in this initiative, explains the importance of surgical volume to its potential patients and lists the frequency of 11 procedures performed at its hospitals on its website. 

The evidence that volume matters to surgical outcomes is strong. This 2015 US News and World Report article discusses the issue from a variety of perspectives and provides examples of the importance of volume for surgical cases, including for common surgeries such as a knee replacement.  

The takeaway: a low volume surgeon or hospital may provide a good outcome, but overall patients are likely to have fewer complications and better outcomes in the hands of an experienced surgeon and facility. While it would be nice, we do not have to wait for hospitals to take the volume pledge. Don’t be shy about asking a surgeon directly, or the physician that refers you to a surgeon, for the number of times that they completed this surgery at the recommended facility in the past year. 

Leapfrog was founded to shine a light on hospital performance so that employers and patients could use their purchasing power to reward the top achievers and foster a marketplace for high-value care. Leapfrog reporting has expanded. Today you will find a letter safety grade for every general hospital in the US, as well as measures of infection rates, Cesarean section rates, and health equity. 

Leapfrog’s success depends on all of us using information to seek the safest and best quality care. The BHC is proud to support this effort as a Leapfrog Regional Leader in the St. Louis area. We will continue to highlight Leapfrog advancements and support employer members and the public in accessing and understanding the information. Please let us know how we can assist as you explore the available data.

Warm Regards,

Louise Y. Probst

BHC Executive Director