The Leapfrog Group is a nonprofit group that goals to assist customers make knowledgeable choices about their well being and entry secure, high-value care. For over 20 years, it has collected and printed information on affected person security and high quality of care from voluntary surveys and different sources.
The Leapfrog Group utilized the next standards to find out which pediatric hospitals certified for the Greatest Pediatric Hospital Listing. All pediatric hospitals that accomplished a Leapfrog Survey had been eligible for consideration.
For the whole methodology, learn under.
I. A hospital should obtain, make appreciable progress, or make some progress in direction of reaching Leapfrog’s normal for Affected person Expertise, primarily based on responses to the CAHPS Youngster Hospital Survey.
Hospitals that care for kids ought to survey these youngsters and their households on necessary points like communication with docs and nurses, communication about medicines, and whether or not they had been advised methods to report issues they noticed. Hospitals report on the outcomes of a nationally standardized affected person expertise survey known as the CAHPS Youngster Hospital Survey. Leapfrog has further info on Expertise of Youngsters and their Mother and father.
Hospitals that obtain Leapfrog’s normal are within the prime percentile of hospitals, primarily based on factors achieved by way of combination scoring of particular person domains’ High Field Scores. Quartiles had been decided utilizing hospital efficiency reported in 2019 and 2020 Leapfrog Hospital Surveys submitted by Aug. 31, 2020.
II. A hospital should obtain, or make appreciable progress in direction of reaching, Leapfrog’s requirements for Head and Stomach/Pelvis Pediatric Computed Tomography (CT) Radiation Doses.
As a result of radiation used for Computed Tomography (CT) is way increased than typical radiographs (x-rays), it will be significant for hospitals to observe their dosage when scanning youngsters given their smaller measurement and decrease physique weights. Hospitals report their doses for routine stomach/pelvis and head CT scans. Learn extra about Leapfrog has further info on Radiation Dose for Head Scans and Radiation Dose for Stomach/Pelvis Scans.
Leapfrog assesses hospitals on their efficiency for head scans and stomach/pelvis scans individually by evaluating the median radiation dose size product (DLP) for every anatomic area and age stratum to 2 benchmarks. The primary benchmark is the Median Benchmark, which is the median of the median doses reported throughout all Leapfrog-reporting hospitals from 2020 Leapfrog Hospital Surveys submitted by January 31, 2021. The second benchmark is the seventy fifth Percentile Benchmark, which is the median of the seventy fifth percentile doses reported throughout all Leapfrog-reporting hospitals from 2020 Leapfrog Hospital Surveys submitted by Jan. 31, 2021.
Hospitals that obtain Leapfrog’s normal on every sort of physique scan are within the prime percentile of hospitals, primarily based on factors achieved by way of combination scoring of particular person age vary strata. Hospitals that don’t carry out CT scans on pediatric sufferers or have fewer than 10 CT scans for all age ranges for a sort of physique scan should not assessed on one or each requirements.
Provided that doses of radiation used for Computed Tomography (CT) are far increased than typical radiographs (x-rays), it will be significant for hospitals to evaluate the dosage publicity for his or her sufferers, particularly pediatric sufferers given their smaller measurement and decrease physique weights. The purpose of the measure is to offer a framework the place amenities can simply assess their doses, evaluate them to benchmarks, and take corrective motion to decrease their doses in the event that they exceed threshold values.
III. A hospital should obtain Leapfrog’s normal for Computerized Doctor Order Entry (CPOE).
Observe: For pediatric hospitals, the CPOE Analysis Software doesn’t apply.
Docs and different licensed prescribers ought to order drugs by way of a pc that alerts them to severe ordering errors, akin to a improper dose or a affected person allergy, to scale back and forestall adversarial drug occasions. Hospitals report on each the utilization of computerized doctor order entry (CPOE) and the effectiveness of that system in alerting prescribers to ordering errors. Leapfrog has extra info on Secure Treatment Ordering.
Leapfrog’s normal for Computerized Doctor Order Entry (CPOE) measures the extent to which a hospital has adopted CPOE, and whether or not decision-support instruments within the CPOE system are working successfully. To realize this normal, physicians should enter a minimum of 85% of treatment orders by way of a CPOE system and display through a web-based, timed analysis, that their inpatient CPOE system can alert physicians to a minimum of 60% of frequent, severe prescribing errors.
CPOE techniques can scale back the variety of ADEs by as much as 88%, stopping 3 million severe treatment errors within the U.S. every year.
IV. A hospital should obtain, or make appreciable progress in direction of reaching Leapfrog’s normal for Bar Code Treatment Administration (BCMA).
Bar code treatment administration (BCMA) techniques are digital scanning techniques that use each a bar code on a affected person’s ID bracelet and the treatment bundle to assist guarantee the precise affected person will get the precise treatment on the proper time. Hospitals report on the proportion of inpatient models during which BCMA is used, the proportion of treatment administrations the place each the affected person and medicine had been scanned in models the place BCMA is getting used, the usage of scientific choice assist to alert nurses if one thing is improper (i.e. improper affected person), and buildings to scale back workarounds that lower the effectiveness of BCMA techniques. Leapfrog has extra info on Secure Treatment Administration.
Leapfrog’s normal for Bar Code Treatment Administration measures the utilization of BCMA in choose inpatient models, compliance with scanning, choice assist provided by the system, and adherence to buildings that may scale back workarounds that lower the effectiveness of BCMA techniques. To realize the usual, hospitals should make the most of a BCMA system in 100% of relevant models (medical and/or surgical models (grownup and pediatric), intensive care models (grownup, pediatric, and neonatal), and labor and supply models), have a minimum of 95% compliance with scanning, have all 5 choice assist parts, and have carried out a minimum of 6 of the 8 practices to scale back workarounds.
V. A hospital should obtain Leapfrog’s normal for ICU Doctor Staffing (IPS).
Hospitals are requested whether or not physicians who’re board-certified in crucial care drugs (referred to as “intensivists”) look after grownup and pediatric crucial care sufferers, the extent of their protection of that care, and whether or not they’re answerable for admission and discharge choices. A crucial care unit or Intensive Care Unit (ICU) is a particular a part of the hospital that gives care for terribly in poor health sufferers. Leapfrog has extra info on Essential Care.
Hospitals reaching Leapfrog’s normal for ICU Doctor Staffing should function grownup and/or pediatric ICUs which might be managed or co-managed by intensivists who: a) Are current throughout daytime hours and supply scientific care solely within the ICU OR are current through telemedicine 24/7, with some on-site intensivist presence, and, b) When not current on website or through telemedicine, return pages a minimum of 95% of the time (i) inside 5 minutes and (ii) prepare for an authorized doctor or doctor extender to achieve ICU sufferers inside 5 minutes. Hospitals that shouldn’t have an ICU should not assessed on this normal.
Mortality charges are considerably decrease in hospitals with ICUs managed solely by board-certified intensivists (physicians educated in crucial care drugs). Analysis has proven that there’s a 30% discount in general hospital mortality and a 40% discount in ICU mortality in ICUs the place intensivists handle or co-manage all sufferers.
VI. A hospital should absolutely adjust to the weather of Leapfrog’s By no means Occasions coverage.
Though uncommon, some medical errors are so severe that consultants agree they need to by no means occur to a affected person. These sorts of errors embody leaving an object inside a affected person’s physique after surgical procedure or working on the improper physique half. Hospitals report on their adoption of 9 (9) actions that ought to happen following a by no means occasion. Leapfrog has extra info on Responding to By no means Occasions.
Leapfrog makes use of the Nationwide High quality Discussion board’s record of significant reportable occasions in asking hospitals to undertake a By no means Occasions coverage. Leapfrog’s By no means Occasions coverage asks hospitals to decide to 9 fundamental acts if a By no means Occasion does happen: apologize to the affected person and household, waive all prices associated to the occasion and follow-up care, report the occasion to an exterior company, conduct a root-cause evaluation of how and why the occasion occurred, make a replica of this coverage out there to sufferers, interview sufferers/households to tell root trigger evaluation, inform affected person/households of actions taken by hospital to forestall related By no means Occasions sooner or later, have a protocol to offer assist for caregivers concerned in By no means Occasions, and carry out an annual evaluate to make sure compliance with Leapfrog’s By no means Occasions Coverage for every By no means Occasion that occurred. Hospitals that obtain Leapfrog’s normal have all 9 parts of the coverage in place and are demonstrating their dedication to treating sufferers, purchasers, and payers with respect when a By no means Occasion happens.
VII. Secure Practices: A hospital should excel on the vast majority of the Secure Practices.
To offer secure, high-quality care, hospitals should implement insurance policies and protocols to handle and scale back errors. Affected person outcomes are impacted when hospital leaders make deliberate and hospital-die dedication to those practices. Extra details about Leapfrog’s info on Stopping and Responding to Affected person Hurt and on Handwashing.
Hospitals assembly this ingredient earned “Achieved the Customary” for a minimum of three of the 4 Secure Practices and didn’t earn “Restricted Achievement” for any of the 4.
These practices embody:
- Efficient Management to Forestall Errors (NQF Secure Apply 1): Hospital management buildings and techniques have to be established to make sure and perpetuate a Tradition of Security.
- Employees Work Collectively to Forestall Errors (NQF Secure Apply 2): Hospitals should guarantee affected person security tradition is measured, the suggestions is offered to all ranges of the group, and interventions are undertaken that scale back affected person hurt.
- Help for Nursing Workforce (NQF Secure Apply 9): Hospitals ought to implement crucial parts of a well-designed nursing workforce that mutually reinforces affected person safeguards.
- Handwashing: Hospitals ought to adhere to a number of practices concerning hand hygiene, together with practices round monitoring, offering suggestions, coaching and training, infrastructure and tradition.