Leapfrog survey may not accurately report use of safe practices in trauma centers
Patients fare no better at trauma centers that comply with safe practices outlined by the Leapfrog Group than those at less compliant centers, according to a new study. It found that patients at high-compliance level I or level II trauma centers did not have lower risk of death or hospital-associated infections (HAIs) than those at less compliant centers. To improve patient outcomes, the Leapfrog Group evaluated the adoption of a set of Safe Practices for Better Healthcare by hospitals. These practices include use of teamwork training, disclosure of adverse events, pressure ulcer prevention, and the use of prevention measures for ventilator-associated pneumonia and venous catheter bloodstream infections.
After controlling for potential patient- and hospital-level confounders, the total score on the Leapfrog Safety Practices Survey was not significantly associated with either mortality or HAIs. The one exception was a 13 percent lower risk of dying with disclosure of adverse events. Some of the safety practices were associated with increased risk of HAI (by 35 percent for pressure ulcer prevention, 17 percent for prevention of wrong-site surgery, and 11 percent for prevention of heart attack). Curiously, implementation of the two practices directly aimed at preventing HAIs (prevention of central line catheter-associated bloodstream infection and prevention of ventilator-associated pneumonia) did not significantly alter patient risks of mortality or HAI at a trauma center.
This finding suggests to the researchers that there may be problems, not with the safe practices, but with the ability of the Leapfrog survey to accurately report their use. The study used data from the 2006 AHRQ-sponsored Healthcare Cost and Utilization Project National Inpatient Sample, which is the largest all-payer inpatient database of patients in the United States. The study sample consisted of 42,417 patients admitted to 58 level I or II trauma center hospitals. The study was funded in part by the Agency for Healthcare Research and Quality (HS16737).
More details are in "Relationship between Leapfrog Safe Practices Survey and outcomes in trauma," by Laurent G. Glance, M.D., Andrew W. Dick, Ph.D., Turner M. Osler, M.D., and others in the October 2011 Archives of Surgery 146(10), pp. 1170-1177.
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