Methodology

Leapfrog evaluates almost 3,000 general acute care hospitals across the United States twice a year. A panel of patient safety experts selects appropriate measures and develops a scoring methodology.

The expert panel selected 22 evidence-based measures of patient safety, including CMS Medicare PSI 90 Patient Safety and Adverse Events composite. The weight of each measure was based on evidence, opportunity for improvement, and impact.

The Leapfrog Hospital Safety Grade placed each measure into one of two domains:

1.       Process/structural measures, which represent how often a hospital gives a patient a recommended treatment for a given medical condition or procedure and the environment in which they receive care.

2.       Outcome measures, which represent what happens to a patient while they receive care.

Each domain accounts for 50% of a hospital's overall score, and a hospital must have enough safety data available for Leapfrog's experts to issue them a letter grade. Currently, Veteran's Affairs hospitals, critical access hospitals, specialty hospitals, children's hospitals, and outpatient surgery centers are not included in the safety grades.

How hospitals performed

In the latest report, of the almost 3,000 general acute care hospital graded:

• Almost 32% earned an "A"
• 24% earned a "B"
• 36% earned a "C"
• 7% earned a "D"
• Less than 1% earned an "F"

A total of 1,788 hospitals, or a little more than two-thirds of those graded, kept the same grade from the spring report, while 45 hospitals fell by two grades, and 62 hospitals improved by two grades.

The states with the highest percentage of "A" grade hospitals were:

• Utah
• Virginia
•  Connecticut
• North Carolina
• New Jersey
• California
• Rhode Island
•  Idaho
• Pennsylvania
• Colorado
• South Carolina

There were no "A" grade hospitals in Iowa, North Dakota, South Dakota, or Vermont.

According to Leapfrog, healthcare-associated infections have improved significantly since fall 2022, when they were at their highest rates since 2016. On average:

• Central line-associated bloodstream infections have decreased by 38%
• Catheter-associated urinary tract infections have decreased by 36%
• Methicillin-resistant Staphylococcus aureus has decreased by 34%

Hospitals have also improved their hand hygiene, going from only 11% meeting Leapfrog's standard in 2020 to 78% in 2024.

Leapfrog also noted that medication safety has improved over the last few years. In 2018, only 65.6% of hospitals met Leapfrog's standards of using Computerized Physician Order Entry systems to catch common errors in prescribing. This number increased to 88.1% in 2024. Similarly, only 47.3% of hospitals used Bar Code Medication Administration systems in 2018, which increased to 86.9% this year.

Commentary

"Preventable deaths and harm in hospitals have been a major policy concern for decades. So, it is good news that Leapfrog's latest Safety Grades reveal that hospitals across the country are making notable gains in patient safety, saving countless lives," said Leapfrog Group president and CEO Leah Binder. "Next, we need hospitals to accelerate this progress—because no one should have to die from a preventable error in a hospital."

According to William Isenberg, chief medical and quality officer at Sutter Health, communication challenges are the biggest obstacles hospitals need to overcome if they want to improve their patient safety scores.

"Communication is really the goal and the ability to speak up and not feel like you're going to be thwarted if you say something is really one of the key success factors," Isenberg said. "When I'm in the operating room, for example, if something doesn't look right, I don't want the nurse to hand me the scalpel to make the incision. It's really important that everybody in that team feel that we're good to go. If you're not focusing on the team's performance, you're missing out on the opportunity to get an 'A.'" (DeSilva, Modern Healthcare, 11/14; Leapfrog Group "About the Grade," accessed 11/18; Leapfrog Group press release, 11/15; Leapfrog Hospital Safety Grades, accessed 11/18)

Download quick guides that summarize the methodology and metrics used in four hospital quality rating programs.