Leapfrog Group Fall 2023 Grades: Hospitals reduce infections, but slip in patient experience

After seeing a substantial rise in hospital-acquired infections during the COVID-19 infection, health systems have made progress in reducing infections, according to the Leapfrog Group.

A nonprofit group focused on patient safety, The Leapfrog Group released its fall 2023 Hospital Safety Grades today. The group assigned letter grades to nearly 3,000 general hospitals and analyzed key safety measures.

While hospitals fared better in reducing infections after seeing disturbing spikes in the Leapfrog Group’s spring report, the report card showed health systems saw declines in the measures of patient experience. It’s the second year in a row that hospitals moved backwards in patient experience.

Leah Binder, president and CEO of The Leapfrog Group, said health systems have some work to do, particularly in the area of patient experience. But she says she’s heartened to see progress in reducing infections.

“I'm certainly encouraged,” Binder says. “But I'm also relieved. We were alarmed by the spike in infections during the pandemic. I mean, this was a spike, this was a very substantial increase that happened, and it scared us. And we thought perhaps hospitals have lost some important capacity to keep infections at least at a reasonable level.”

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In an interview with Chief Healthcare Executive®, Binder discusses the report, the success with reducing infections, the need to do better, and the disappointing feedback from patients.

(See part of our conversation in this video. The story continues below.)

Progress with infections

In the new report card examining hospital performance in 2023, Leapfrog found declines in three hospital-based infections which had reached a five-year high in the COVID-19 pandemic: Methicillin-resistant Staphylococcus aureus (MRSA), central line associated bloodstream infections, and catheter-associated urinary tract infections.

“We were concerned that hospitals had somehow lost progress that they've made over the past decade,” Binder says. “And so now we're seeing it's quickly coming way down. And that is extremely encouraging, in particular central line infections. Those have shown a very significant decrease.”

The Leapfrog Group analysis found that 19% of hospitals improved in all three infections, and 66% of hospitals made progress in at least one of the infections. Conversely, 16% of hospitals made no improvement or saw an uptick in those infections.

Hospitals deserve credit for their success in reducing infections, Binder says, noting that central line and MRSA infections can be potentially fatal.

“All three of these infections cause catastrophic levels of suffering for people, and it's unnecessary,” she says. “We can do better.”

When asked if she expected improvement, Binder says, “Frankly, I wasn’t sure what to expect.”

“I want to be an optimist,” she says. “And I want to believe that hospitals were as concerned as we were about the spike in infections. And clearly they were concerned. I wanted to believe that they would make this a top priority, because that's what it takes to bring them down. You just have to make it a priority … And they did, because they reduced the infections.”

Federal officials said the COVID-19 pandemic eroded gains in patient safety. In an analysis published in the New England Journal of Medicine in February 2022, they cited sharp increases in infections. While officials acknowledged that hospitals faced unprecedented challenges in the pandemic, they said they were worried by the reversal of progress in patient safety occurring so quickly.

Even with progress, infection rates remain higher than pre-pandemic levels, Binder says.

“We are encouraging hospitals to get it down even further and get it below where it was before the pandemic. Clearly, we know how to bring it down,” Binder says.

Patient experience

While encouraged by the progress in reducing infections, the report found that measures of patient experience declined for the second consecutive year. All states have experienced drops in patient experience scores from the fall of 2021 to the fall of 2023, the report found.

The most significant declines occurred in two categories: communication about medicines and responsiveness of hospital staff. Binder says those results are problematic, because they are associated with medical errors that are preventable.

“We are seeing continued declines, even, in some cases, steeper declines that we saw during the pandemic,” Binder says.

Hospitals have been grappling with staffing shortages, which has had an impact on the patient experience, Binder says. The group spoke with hospital leaders and they pointed to the shortage of nurses and other clinicians playing a role. They also point to the rise in burnout among staff having an impact.

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While acknowledging the reality of staffing difficulties at health systems, Binder says, “There may be a workforce shortage but the patient shouldn't have to suffer first for that.”

Health systems need to work in communication and responding to patients, she says.

“It is interesting to us that there's this contradiction in these two trends that we saw post-pandemic, where you see that hospitals are bouncing back on infection rates, and at the same time, they are getting worse on patient experience,” Binder says.

“It is a bit of a puzzle, frankly, because we know hospitals are capable of improving safety because they did it,” she continues. “I mean, they are already showing just a remarkable improvement on infection. That is not something that happens out of nowhere. That is something that happens when hospital leaders and hospitals and clinicians put every resource they have toward this problem.”

Still, health systems need to work in communication and respond to patients, she says.

“They do have some major sort of endemic issues right now that are showing up in this patient experience report. And they're dangerous to patients,” Binder says. “So we really need to start to address those issues.”

In the fall 2023 report, nearly 30% of hospitals received an “A” in the fall 2023 safety grades, while 24% earned a “B”, and 39% of hospitals received a “B.” On the low end, 7% of hospitals received a “D”, and less than 1% earned an “F.”