'F' to 'A': How this Chicago hospital leaped to top safety grade

In past years, leaders at St. Bernard Hospital on Chicago's South Side weren't fans of The Leapfrog Group's safety grades that are handed out twice a year. "F" grades in both spring and fall of 2021 had been stinging reminders that the safety net hospital wasn't doing enough to focus on patient safety.

By spring 2022, and again in fall 2022, the hospital worked its way up to "C" grades, but leadership had its sights set on the top grade — and its concentrated focus on safety paid off. When Leapfrog released its 2023 Safety Grades report May 3, St. Bernard found out it had achieved the coveted "A" grade.

Michael Richardson, BSN, RN, chief quality and patient safety officer, said the hospital pivoted its safety strategy when he came on board in September 2021. That's when the hospital's CEO made a commitment to break down departmental silos in the facility and apply comprehensive and consistent safety measures across the board.

"Our CEO wanted to use the Leapfrog survey as a roadmap going forward" for what the hospital needed to do to get its safety score out of the basement. "He wanted a more focused approach, one that would change the direction the hospital was going," Mr. Richardson said, noting the rise from "F" to "C" to "A" took an all-hands-on-deck approach, upgraded safety directives and implementation of technology.

"Two years ago, we gave them 'Fs' because they had very bad infection rate data," said Leah Binder, president and CEO of The Leapfrog Group. "They have vastly improved on all their infections [metrics] plus other measures and now they have earned an 'A.' That's a really big deal."

How St. Bernard did it

Mr. Richardson looked at the low-hanging fruit regarding the hospital's current safety measures. He zeroed in on medication scanning and healthcare-acquired infection rate challenges. St. Bernard's scanning metrics sat at 70 percent, far lower than Leapfrog's recommended 95 percent. Rates of HAIs were high, as well.

He immediately started asking questions such as, "Why aren't nurses consistently cross-checking medication labels and patients?" Turns out, he said, there were Wi-Fi dead spots in some areas of the hospital, medicine bottle barcodes didn't scan well, and, often, the scanning equipment itself didn't work.

"Once we learned this information, we knew we could fix those problems fast. We upgraded the Wi-Fi, fixed the labels and got new scanning equipment," Mr. Richardson said. "Then we focused on the individual behavior of the nurses and respiratory therapists."

In the past 12 months, St. Bernard's medication barcode scanning statistics are even higher than Leapfrog's benchmark. They are consistently in the upper nineties.

He noted St. Bernard wasn't reporting a significant number of adverse events due to the scanning issues, "but we knew that by not scanning medications, eventually, something's going to happen. These processes are in place as safety barriers to prevent errors."

What about hospital-acquired infections?

Leapfrog's spring 2023 report card showed HAIs are at a five-year high. In fact, hospitals in many states reported spikes in three HAIs — central line-associated bloodstream infections, catheter-associated urinary tract infections and methicillin-resistant Staphylococcus aureus — that "alarmed" Ms. Binder and her team at Leapfrog. 

Statistical benchmarks are based on The Leapfrog Group's use of the standardized infection ratio, which compares the number of HAIs at each hospital to the predicted number of infections.

Mr. Richardson confirmed St. Bernard's data on infections had been high, so he focused on hand hygiene policies, noting, "Everybody realizes that lack of hand hygiene causes hospital acquired infections; it's the biggest cause."

St. Bernard hired "secret shoppers," the safety chief said, to manually watch over the process. It was costly and an inconsistent way to monitor compliance. "So we invested in electronic monitoring of hand hygiene practices," he said. "Now the staff wear badges that they scan every time they use a hand sanitizer."

A signal light on the badge starts yellow and turns green — "green means clean," Mr. Richardson said — after the person cleans their hands. The machine beeps after the person enters a patient's room, every 15 seconds, warning them if they don't comply with hand hygiene policies, the badge turns red and the system will record it.

All employees, including Mr. Richardson and his fellow C-suite leaders at the hospital, have been wearing the badges since May 2022. More than 1 million "green lights" have been recorded by the technology in the past year, and St. Bernard hand hygiene compliance is at around 90 percent, far higher than Leapfrog's benchmark.

"We are aiming toward a goal of 95 percent compliance," he said, adding the hospital currently is reporting zero CLABSI and zero CAUTI infections. Initiatives to reduce MRSA infections are ongoing. 

Leapfrog bases its hand hygiene standard, in part, by collecting hand hygiene compliance data on at least 200 hand hygiene opportunities each month, in each patient care unit.

Some hospitals say the Leapfrog grades aren't "fair" and don't accurately describe real-time hospital activities because they are based, in part, on the most recent CMS data available.

"Leapfrog's guidelines are really the industry's patient safety industry standards," Mr. Richardson said. "Hand hygiene, infections, falls with fractures — all hospitals need to look at these types of issues and do something about them. That's what we did here at St. Bernard."

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