1. Results of the 2013 Leapfrog Hospital Survey Developed for The Leapfrog Group by Castlight Heath www.LeapfrogGroup.org/HospitalSurveyReport

2. Rate of hospital participation in the 2013 Leapfrog Hospital Survey by state Responses submitted as of December 31, 2013 SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

3. The Leapfrog standard for CPOE is aimed at ensuring that patients are being prescribed medications through a computerized order entry system that alerts prescribers to drug-drug interactions, drug-allergy interactions, and other potential prescribing errors SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

4. The Leapfrog standard for CPOE is aimed at ensuring that patients are being prescribed medications through a computerized order entry system that alerts prescribers to drug-drug interactions, drug-allergy interactions, and other potential prescribing errors SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

5. Early elective deliveries are scheduled cesarean sections or medical inductions performed prior to 39 completed weeks of gestation without medical necessity, which carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of early elective deliveries before 39 weeks is less than or equal to 5%. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

6. Early elective deliveries are scheduled cesarean sections or medical inductions performed prior to 39 completed weeks of gestation without medical necessity, which carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of early elective deliveries before 39 weeks is less than or equal to 5%. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

7. Early elective deliveries are scheduled cesarean sections or medical inductions performed prior to 39 completed weeks of gestation without medical necessity, which carry risks to both babies and mothers. Leapfrog’s standard is that a hospital’s rate of early elective deliveries before 39 weeks is less than or equal to 5%. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

8. An episiotomy is an incision made in the perineum (the birth canal) during childbirth. Although an episiotomy was once routine in childbirth, medical guidelines today recommend episiotomy only in a narrow set of cases. Leapfrog’s standard is that the hospital’s rate of episiotomy is less than or equal to 12% SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

9. Leapfrog’s standard for High-Risk Deliveries is that the hospital delivers at least 50 very-low birth weight babies per year and ensures that at least 80% of mothers receive antenatal steroids prior to delivery OR the hospital has a lower than average morbidity/mortality rate for very-low birth weight babies. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

10. Leapfrog predicts survival rates for high-risk procedures using two pieces of information: the number of patients who had the surgery at a particular hospital and the number of patients who died from having the procedure at that hospital. The survival rate predictors were developed by Drs. John Birkmeyer and Justin Dimick SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport) 0% 9.3% 20.9% Aortic Valve Replacement Abdominal Aortic Aneurism Pancreatectomy Esophagectomy 3.1%4.8% 7.4% 0.9%3.1% 6.9% 2.5%9.4% 12% Lowest Predicted Death Rate Average Predicted Death Rate Highest Predicted Death Rate 2013 High-Risk Procedure Predicted Mortality Rates as reported to the Leapfrog Hospital Survey

11. Hospital-acquired pressure ulcers at stage III and IV are “bedsores” that are caused by remaining in one position for a long time and can be prevented through known precautions. Stage III and IV pressure ulcers are very deep, serious sores that may reach muscle or bone. Leapfrog’s standard is that the rate of stage III and IV pressure ulcers is zero. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

12. Hospital-acquired injuries are falls and other traumatic injuries (broken or dislocated bones, crushing injuries, or burns) that occur while a patient is in the hospital. Although some falls and injuries may occur when hospitals are providing quality care, many others can be avoided. Leapfrog’s standard is that a hospital’s rate of falls & injuries is close to zero SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

13. Leapfrog uses a standardized infection ratio (SIR) to aggregate a hospital’s performance on Central-Line Associated Bloodstream Infections across multiple ICU types and to standardize the reporting out of a hospital’s performance. The SIR is a ratio of a hospital’s actual number of infections over an expected number of infections. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

14. Leapfrog uses a standardized infection ratio (SIR) to aggregate a hospital’s performance on Catheter-Associated Urinary Tract Infections across multiple ICU types and to standardize the reporting out of a hospital’s performance. The SIR is a ratio of a hospital’s actual number of infections over an expected number of infections. 2013 was the first year that Leapfrog included this measure on the survey. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

15. Hospital-acquired Conditions (HACs) are medical conditions or complications that were not present when a patient was admitted to the hospital, but developed as a result of errors or accidents in the hospital. Hospitals can prevent many of these conditions; some hospitals have zero or close to zero reported HACs. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

16. Research has shown that hospitals staffing their ICUs with physicians who are certified in critical care medicine (intensivists) can reduce ICU mortality by as much as 40%. Leapfrog’s standard asks that patients in adult or pediatric medical and/or surgical or neuro ICUs are being cared for by intensivists. These intensivists are present at least 8 hours a day, 7 days per week. When not present in the ICU, the intensivist responds to pages within 5 minutes or has another physician, physician assistant, nurse practitioner, or trained nurse that does reach the patient within 5 minutes. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

17. Leapfrog’s standard asks that the hospital has a policy in place so that if a Never Event occurs, the hospital will (a) apologize to the patient and/or family (b) report the event to an outside agency (c) perform root-cause analysis (d) waive costs directly related to the Never Event and (e) make a copy of the policy available to patients and payers SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

18. Leapfrog asks hospitals to report on their implementation of eight National Quality Forum-endorsed Safe Practices that, if adopted, can improve patient safety in healthcare settings. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

19. Not having enough nurses and the lack of quality nurse education can expose patients to greater risk. Short staffing in particular has been linked to increased mortality, complications, adverse events, longer hospital stays, and greater resource usage. Leapfrog believes the public deserves to know about hospitals with strong nursing workforces, as this leads directly to increased safety and quality. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

20. Leapfrog is the only ratings provider that tracks and rewards Magnet® Status, an elite designation for nursing excellence, and gives credit to hospitals with this designation as fully meeting Leapfrog’s standard. Developed by the American Nurses Credentialing Center (ANCC), Magnet is the leading source of successful nursing practices and strategies worldwide. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)

21. Many healthcare-associated infections (HAIs) are caused by pathogens transmitted from one patient to another via the contaminated hands of healthcare workers. The CDC estimates that approximately 2 million patients annually acquire an HAI, and nearly 90,000 patients die as a result. Hand hygiene is one of the most important and effective means to stop the spread of pathogens in healthcare facilities. SOURCE: Results of the 2013 Leapfrog Hospital Survey (www.LeapfrogGroup.org/HospitalSurveyReport)