Editor’s note: This is the first story in a series on hospital safety. Subsequent stories will explore the safety grades for specific hospitals in Fort Worth.

People who were hospitalized in the first year of the pandemic said fewer positive things about their hospital stays than patients before the pandemic, according to a Tuesday report from The Leapfrog Group

A patient’s experience in a hospital is a key metric for patient safety, according to the hospital watchdog nonprofit, which assigns a safety grade to nearly 3,000 general hospitals across the U.S. twice a year. 

“The health care workforce has faced unprecedented levels of pressure during the pandemic, and as a result, patients’ experience with their care appears to have suffered,” Leah Binder, president and CEO of The Leapfrog Group, said in the report.

The decline in positive patient experiences didn’t lead to a significant drop in hospital safety grades nationally, Missy Danforth, vice president of health care ratings at The Leapfrog Group, told the Fort Worth Report. Still, the grades for three of seven Fort Worth hospitals that were scored dipped from fall 2021; the other four remained the same. 

Making the grade

To calculate each hospital’s safety grade, The Leapfrog Group analyzes publicly available data from the U.S. Centers for Medicare and Medicaid Services, which requires hospitals to report certain medical errors and survey adult patients who stay overnight. 

Some hospitals also choose to submit supplementary data to The Leapfrog Group through the nonprofit’s hospital survey, but doing so isn’t required to receive a grade, Danforth said.

The U.S. Centers for Medicare and Medicaid Services, or CMS, specifically collects data about hospital-acquired infections, which patients contract while receiving medical treatment, as well as potentially preventable complications that Medicare patients experience after surgery, like falls or sepsis

The federal agency also requires hospitals to survey discharged patients about their stay. The survey is available in seven languages and asks patients about how well their providers communicated, if their hospital rooms were well-maintained, and whether they’d recommend the hospital to friends and family, among other questions.

A growing body of research links patient experience with patient safety, Danforth said. 

“Patients who say, ‘The staff is not responsive,’ we know that that can actually lead to things like patient falls,” she said. 

Interpreting the grade

The spring 2022 hospital safety grades reflect patient experience data during the pandemic for the first time since the pandemic began.

Because CMS publishes data a year or more after receiving it, the hospital safety grades actually reflect “a particular point in time — that tends to be in the past,” Danforth said. This “lag” is the central limitation of the hospital safety grades, she said. 

Across the U.S., patient experience declined in the first year of the pandemic compared to 2019, according to the report. 

Patients were less likely to say providers were responsive to their needs or communicated clearly after the pandemic began. Also, patients were less likely to commend the hospital on its cleanliness compared to before the pandemic. 

Only one measure improved, according to the report: how quiet the area around the patient’s room remained at night, a possible consequence of visitor restrictions.

Despite the decline in the particular metric of patient experience, the data didn’t indicate significant changes in the overall distribution of safety grades compared to before the pandemic, Danforth said.

Using the grade

When Lillee Gelinas, a nurse and course director for patient safety at the Texas College of Osteopathic Medicine, talks to her students about hospital quality, she asks them: How do you determine the quality of restaurants? Cars? Products on Amazon? 

Their answers are predictable: Her students look at reviews.

“‘If it’s not four or five stars, I keep looking,’” she said they tell her. Their pursuit of external reviews, however, doesn’t extend to hospitals.

“Consumers still don’t know how to check (health care) performance ratings through the eyes of others,” she said.

She encourages them to assess a hospital through three websites: qualitycheck.org, which allows people to check the Joint Commission accreditation status of a hospital; the CMS website, for patients’ perspectives on hospital care; and Leapfrog. Also, she recommends they scope out a hospital’s website: Does it specifically mention patient safety in its mission statement, or as part of its goals or values?  

Her students — future physicians — can’t fix a hospital’s bad grade. But, she said, they can pursue patient safety in their own practice.

“I can’t be accountable for the organization where our students are going to practice one day, but I can help them understand their individual accountability and contributions to a safe environment,” Gelinas said. 

As for Danforth, she hopes the scores not only serve as guideposts for patients, but galvanize hospitals to prepare to protect patients should future public health emergencies or staffing shortages arise.

“If I’m the leader of a hospital today,” she said, “I need to have a real focus not just on reaching a certain level of harm reduction, but really maintaining that over time, even as things around me change.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....