This initiative was introduced following the publication by the Institute of Medicine of "To Err is Human" in November 1999, followed by "Bridging the Quality Chasm" in March 2001. These landmark studies emphasized problems in today’s delivery of medical care and recommended many changes, which the authors felt would result in improvements.
Local members of the Leapfrog Group include Caterpillar Inc., IBM, Verizon Communications, AT&T and Cargill Inc.
The group noted five considerations they feel make the case for their action:
- American health care remains far below obtainable levels of basic safety and overall customer value.
- The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value.
- Purchasing strategies need to champion superior overall value and focus on specific innovations offering great leaps in basic patient safety.
- Voluntary commitments to purchasing principles by a critical mass of America’s largest employers will jump-start other purchasers to join.
- Consumer understanding of and support for safety leaps and other critically-needed improvements in health care value are pivotal to success. To accomplish these goals the group identified four initial guidelines, which they feel would substantially reduce medication error, improve safety and reduce mortality.
The guidelines are:
- High-risk surgery (carotid endarterectomy, aneurysm resection, coronary artery bypass, coronary angioplasty, esophageal resection for cancer) should be performed only in medical centers performing more than a defined amount of cases annually.
- Hospital intensive care units should be staffed by full-time, dedicated intensive care physicians.
- Hospitals should implement computerized physician order-entry (particularly for medication). Ideally this should include prompts and warnings at the time orders are entered.
- High-risk deliveries should be referred to hospitals with active perinatal services and neonatal ICU units, which care for more than a defined amount of high-risk infants annually.
The Leapfrog Group recognized many of these standards could only be met in the urban hospital environment where volume allows the attainment of numbers to meet their standards. They submitted extensive survey documents to hospitals in selected states and cities in an effort to collect data on the current status and to allow ongoing analysis to direct their future efforts.
This is an important development in health care in that the purchasers of health care are looking more closely at the quality and value of the services for which they are contracting. If the initiative is conducted with the cooperation of hospitals and health care systems—and continues to be based on valid, statistically sound process and outcomes data—it will greatly benefit the patients. The initiative must meet the demands of evidence-based decisions for it to continue to be a positive force. An existing lack of sufficient physician manpower may temporarily limit staffing all ICU units with physicians trained in these disciplines.
For information about The Leapfrog Group, visit http://www.leapfroggroup.org. IBI