The Leapfrog Group’s Patient Safety Practices, 2003: The Potential Benefits of Universal Adoption Research Director

Executive Summary 1 Computer physician order entry (CPOE) Summary of analysis 4 Selected bibliography 7 Figure 1: Calculating serious medication errors avoided 8 Table 1: Studies assessing the effectiveness of CPOE on medication errors 9 Table 2: Relationship between hospital size and adoption of CPOE 10 Table 3: Studies assessing the effect of CPOE on other outcomes 11 Figure 2: Sensitivity analysis 12 Evidence-based hospital referral (EHR): High-risk surgery Summary of analysis 13 Selected bibliography 18 Table 1: Criteria for full adherence to the 2003 standards for high-risk surgery 19 Figure 1: Mortality rates at high and low volume hospitals 20 Table 2: Lives saved with pancreatic resection 21 Table 2: Lives saved with esophageal resection 22 Table 2: Lives saved with abdominal aortic aneurysm repair 23 Table 2: Lives saved with coronary artery bypass grafting 24 Table 2: Lives saved with percutaneous coronary intervention 25 Evidence-based hospital referral (EHR): High-risk neonatal intensive care Summary of analysis 26 Selected bibliography 29 Table 1: Criteria for full adherence to the 2003 standards for neonatal ICU care 30 Table 2: Lives saved for infants with congenital anomalies 31 Table 2: Lives saved for very low birth weight and/or very premature infants 32 ICU Physician Staffing (IPS) Summary of analysis 33 Selected bibliography 38 Table 1: Studies on the effectiveness of IPS 39 Figure 1: Number of lives potentially saved by IPS 40 Figure 2: Effect of IPS on mortality from each study 41 Figure 3: Sensitivity analysis for adult ICUs 42 Figure 4: Sensitivity analysis for pediatric ICUs 42 1 EXECUTIVE SUMMARY The Leapfrog Group is a large coalition of more than 150 private and public sector health care purchasers working together to improve the quality of healthcare. The Leapfrog Group's quality improvement efforts highlight three main areas: 1) computer physician order entry (CPOE); 2) evidence-based hospital referral (EHR) for high-risk surgery and neonatal intensive care; and 3) ICU physician staffing (IPS). The following report estimates the benefits that could potentially be achieved if every non-rural hospital in the United States complied fully with the 2003 Leapfrog safety standards. As in our previous analysis for the 2000 standards, we approached the analysis in two steps. First, we estimated the population at risk—the number of patients in metropolitan areas who are currently receiving care in hospitals not meeting the Leapfrog standards. Second, we estimated baseline risks in hospitalized patients, and the potential risk …