How Safe is Your Hospital?

Frequently Asked Questions About The Leapfrog Hospital Safety Grade

Who is The Leapfrog Group? 

The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps forward in the quality and safety of American health care. For over 20 years, we have served as the nation’s leading independent advocate of health care transparency to drive major improvement in patient safety, rating health care facilities to help people make informed, lifesaving decisions about where to seek services, and giving purchasers tools to tie their purchasing strategy to excellence in safety and quality.

What is The Leapfrog Hospital Safety Grade? 

The Leapfrog Hospital Safety Grade is an “A,” “B,” “C,” “D,” or “F” assigned to general hospitals in the U.S., the only such rating program focused exclusively on how safe they are for their patients. The grade uses over 30 measures including rates of preventable errors, injuries, and infections, and whether hospitals have systems in place to prevent them. Grades are updated twice annually, in the fall and spring, and are freely available to the public at The Hospital Safety Grade uses a public, peer-reviewed methodology, calculated by top patient safety experts under the guidance of a National Expert Panel, and is 100% transparent and free to the public.

Why should people worry about a hospital’s patient safety? Aren’t all hospitals the same?  

It is critical to monitor safety before choosing a hospital. Preventable medical errors, accidents, injuries, and infections in hospitals kill upwards of 200,000 people every year, the third leading cause of death in the United States. One in four people admitted to a hospital suffers some form of avoidable harm. And all hospitals are not the same; some hospitals are much safer than others. Johns Hopkins Medicine researchers estimate that patients are twice as likely to die of a preventable problem at a C, D, or F hospital than an A hospital, and over 50,000 lives would be saved if all hospitals performed the way A hospitals did. 

What is the difference between the Leapfrog Hospital Survey and the Leapfrog Hospital Safety Grade? 

The Leapfrog Hospital Survey is an annual voluntary survey in which Leapfrog asks hospitals to report quality and safety data and then publicly reports that information by hospital. The Leapfrog Hospital Safety Grade is a letter grade Leapfrog bi-annually assigns to general hospitals in the United States, whether they voluntarily report data to Leapfrog or not. If a hospital does not report to the Leapfrog Hospital Survey, other sources of data are used to calculate a Grade. The majority of data used to calculate the Safety Grade comes from the Centers for Medicare and Medicaid Services (CMS).

Does a hospital get a better Safety Grade if it reports to the Leapfrog Hospital Survey?  

The Hospital Safety Grade reflects how well a hospital does on safety, not whether they complete the Leapfrog Hospital Survey. The more information Leapfrog has about a hospital’s safety, the more opportunity hospitals have to tell their story. Participation in the Leapfrog Hospital Survey gives hospitals the opportunity to report additional information about their safety measures. If a hospital performs well on certain measures on the Leapfrog Hospital Survey, they have the opportunity to earn more points in their Hospital Safety Grade for those certain measures than they would if they did not report to the Leapfrog Hospital Survey. This is because the data hospitals report to Leapfrog is more comprehensive than data available from other publicly available sources. On the other hand, hospitals that perform poorly on Leapfrog Hospital Survey measures that are included in the Safety Grade will also feel the impact of that performance on their grade.

Why don’t I see my hospital? 

Unfortunately, not all hospitals have enough data publicly available to be eligible for a grade. As per the National Expert Panel guidance, The Leapfrog Group has requirements for the minimum amount of data we need to issue an accurate grade. Most of the data Leapfrog uses comes from the federal agency Centers for Medicare and Medicaid Services (CMS), and in some cases, CMS does not publish adequate safety data on an individual hospital. Sometimes the hospital is too small to issue reliable numbers, and sometimes the hospital does not offer services relevant to the safety data. For instance, a hospital without an Intensive Care Unit (ICU) cannot report ICU safety measures. The absence of a grade does not mean a hospital is unsafe; it means Leapfrog does not have enough data to assign a grade.

How does Leapfrog determine the Grades? 

Leapfrog experts and advisors at the Johns Hopkins Armstrong Institute for Patient Safety and Quality regularly review all publicly available measures of safety and the methodology to determine a hospital’s letter grade. The National Expert Panel regularly convenes to review the methodology for validity and reliability. The scoring methodology is published in detail, and hospitals are given tools to analyze how their own grade was derived. 

What changes in Hospital Safety Grades have been seen when comparing post-pandemic Safety Grade data? 

Since the start of the pandemic, patient experience has steadily declined. The spring 2024 Hospital Safety Grade has shown the first sign of improvement, with all measures significantly improving since fall 2023, but the measures are still far from pre-pandemic levels. Patient experience is measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which the Centers for Medicare and Medicaid Services (CMS) uses to publicly report patients' perspectives of hospital care.

Healthcare-associated infections (HAIs) continue to see an encouraging downward trend. Since Leapfrog reported Hospital Safety Grades in fall 2022, when HAI rates were at their highest peak since 2016, 92% of hospitals have improved performance on at least one of three dangerous preventable infections. Average HAI rates have nationally declined dramatically: 

  • Central line-associated bloodstream infections (CLABSI) decreased by 34%
  • Catheter-associated urinary tract infections (CAUTI) decreased by 30%
  • Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 30%

Are there new measures on the spring 2024 Leapfrog Hospital Safety Grade?

There are no new measures on the spring 2024 Hospital Safety Grade, but in fall 2023, Leapfrog added a new nursing workforce measure with data taken from the 2023 Leapfrog Hospital Survey: Total Nursing Care Hours per Patient Day. This is a National Quality Forum (NQF) endorsed measure that includes hours for all hospital team members in charge of bedside care including RNs, LPN/LVNs, and unlicensed medical personnel.  

Should patients avoid a “C,” “D,” or “F” hospital? What should people do if the only hospital in their community is a “C,” “D,” or “F?” 

When they have a choice, the Hospital Safety Grade is the first tool patients should use to select a hospital, because safety should come first. The Hospital Safety Grade is the only public rating exclusively focused on safety—how well the hospital protects patients from medical errors, accidents, injuries, and infections that kill more than 200,000 people a year in the United States.

Once satisfied with the hospital’s record on safety, then people should consider other aspects of hospital performance in the decision-making process. This may include whether the hospital delivers a high level of care for the health concern the patient has, i.e., if the hospital has high-quality obstetrics or orthopedics. In some cases, the only hospitals available in a community are not highly rated.

Leapfrog offers guidance and resources on our website for patients and family members to protect themselves during a hospital stay, which is important no matter the hospital’s grade. It can be difficult, but patients and families must take an assertive role in managing bedside care to avoid many of the most common errors that routinely occur in hospitals at all grade levels.