1. Computerized physician order entry
6
(CPOE). This has been shown to
significantly reduce serious
prescribing errors in hospitals.
2. Evidence-based hospital referral.
Referring patients who need certain
complex medical procedures to
hospitals that offer the best
survival based on scientifically
valid criteria can reduce mortality
risk by more than 30 percent.
3. Intensive care unit (ICU) physician
staffing. If ICUs are staffed 24
hours a day by physicians trained
in critical care medicine, the death
rate of ICU patients can be reduced
by more than 10 percent.
These standards apply to urban
and suburban hospitals only; rural
hospitals have been excluded (The
Leapfrog Group 2003). Hospitals are
asked to voluntarily complete the
Leapfrog Survey, which includes
questions about compliance or plans
to comply with the recommendations.
The results of the survey as of late
2003 are as follows:
■ Less than 4 percent of responding
hospitals had CPOE.
■ Only 19 percent had fully
implemented ICU staffing.
■ The volume criteria for certain
procedures were fulfilled by
28 | LEADING A PATIENT- SAFE ORGANIZATION
between 12 percent and 15.
percent of responding hospitals.
The lowest percentage was for
coronary artery bypass surgery and
the highest was for abdominal
aortic aneurysm repair.
Problems with the Standards
Adhering to these three standards is
difficult because of the following
reasons:
■ CPOE is expensive and has
sustained a number of highly
publicized failures that are
primarily related to physician
resistance (Ornstein 2003). Modern
Healthcare’s annual information
technology survey revealed that
healthcare executives were less
inclined to implement CPOE in
2004 than in 2003 (Morrisey 2004).
■ Only a few studies quantify the
impact of CPOE on drug errors. The
major institutions that are reporting
success are Brigham and Women’s
Hospital in Boston and LDS in Salt
Lake City (Mello, Studdert, and
Brennan 2003).
■ Physician staffing for ICUs is
problematic given the relative
shortage of trained intensivists.
■ Implementing volume criteria
dramatically changes referral
patterns and causes patients to