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All Hartford HealthCare hospitals earn straight A’s for safety from Leapfrog

November 06, 2023

Hartford HealthCare’s report card is in — and it’s honor roll time.

All seven Hartford HealthCare hospitals received A grades for safety grades from The Leapfrog Group, the nation’s leading independent watchdog for analyzing safety and quality data. Very few health systems in the nation have ever achieved straight As for safety.

The latest ratings mean patients have access to the safest level of care no matter which Hartford HealthCare hospital they choose.

“This extraordinary accomplishment can only happen with a dedicated team that has a singular focus — ensuring patients have access to world-class healthcare,” says Jeffrey A. Flaks, president and chief executive officer of Hartford HealthCare. “This makes a huge difference for everyone who trusts us with their care. Safety is at the heart of promise we make to our communities. Our commitment leads to innovation, process improvement and best practices that we employ across our entire system.”

More than ever, patients look to Leapfrog and other rankings to help them make care decisions for themselves and loved ones. Patients at hospitals with D or F grades face a 92% higher risk of avoidable death, according to Leapfrog.

We did our homework

Hartford HealthCare’s success is rooted in executive support, continuous training and resources for initiatives designed to improve care quality and reduce incidents of hospital-acquired infections, pressure ulcers and human error.

“The differentiator is our intentional focus and commitment to quality and safety,” says Stephanie Calcasola, Hartford HealthCare vice president of quality and safety. “Our entire organization is creating goals around patient safety, utilizing tools to understand performance and, with that performance, creating action plans to continuously improve.”

Quality and safety journey

In 2019, Hartford HealthCare committed to becoming a high-reliability organization, a blame-free environment where colleagues feel safe pointing out mistakes to improve patient safety.

Results included:

  • Achieving a 39% Serious Safety Event Rate reduction at all hospitals from September 2019 to July 2023.
  • In the same timeframe, realizing a 40% reduction in hospital-acquired infections (HAIs) across all hospitals.

Becoming a high-reliability organization, which included colleague training initiated in 2021, and some early wins led to projects addressing:

  • HAIs. From MRSA and clostridiodes difficile (C.diff) to catheter-associated urinary tract infections, patients can acquire various infections while hospitalized. Advancements included:
    • Bedside checklists helping clinicians spot infections early enough to quickly and effectively treat.
    • Device removal timeouts stopping work so teams can focus on whether patients need catheters or they can come out. Removal decreases infection risk.
    • Reducing unnecessary testing and lab work.
    • Embedding team huddles in standard work.
    • Accountability models empowering colleagues to raise concerns.
    • Standardized tools outlining steps to avoid and/or treat infection so care is uniform systemwide, adds Ajay Kumar, MD, Hartford HealthCare’s executive vice president and chief clinical officer.
    • Engaged patients on HHC’s Board of Directors Quality & Safety Committee.
  • Hand hygiene. Always a priority at HHC, Calcasola says efforts heightened during the pandemic and have been maintained.
  • Human error. Checking and double-checking helps curb human error. Examples include:
    • Bar coding medication in the pharmacy. Bedside staff checks medication codes against orders and patients to ensure safe delivery. “Every line item on our plan has a precision focus. In this case, the pharmacy team rolled this out,” Dr. Kumar says.
    • Creating a process to learn from errors, improve systems and prevent mistakes from happening again.
    • Fostering an environment where all voices matter, encouraging colleagues to speak up if they think something is wrong.
  • Pressure ulcers. Damage to skin caused by lying in one position for too long, these can cause serious health issues and death. Efforts include:
    • Thermal scanning technology to spot skin breakdown before it’s visible.
    • Standard protocols directing teams to assess skin condition at admission and periodically during hospital stays.
    • Creation of a nursing council to teach clinical teams how to avoid pressure ulcers and help patients who develop them.
  • Antibiotic stewardship to avoid C.diff and MRSA infection. “We learned there is price to pay for antibiotic over-prescription — adverse side effects, antimicrobial resistance, cost and life-threatening diseases such as C.diff,” explains Ulysses Wu, MD, system director of infectious disease. Over time, he says providers recognized “longer does not equate to better” and limited antibiotic use. “We walk a much finer line these days and, as we continue to learn, we get better in our treatment of patients.”

“The cultural work was critical to getting us where we are now,” says Dr. Kumar. “Nothing happens without observation and follow-up, work that will continue as we ensure the safety of our patients.”