Duke University Hospital’s safety grade dropped from an A to a C this year, based on the Leapfrog Hospital Safety Grade—a nonprofit dedicated to the safety and transparency of hospitals.

Leapfrog analyzes hospital data using national measures of hospital safety, and the overall score measures how well the hospital keeps patients safe from “preventable harm and medical errors.”

Duke University Hospital President Thomas Owens said that the data Leapfrog used is outdated by three years. He explained that in 2014, Duke Hospital began a mobility campaign to keep patients active while admitted. 

“One of the big risks when you’re in the hospital and very sick is that you don’t move and you get weak,” Owens said. “As we started that campaign and had more patients up and moving, we did see an increase in falls. We have worked very hard to try to balance that—keep patients moving and preventing falls.”

The Leapfrog rating placed the hospital worse than average in three out of five types of hospital-acquired infections. For problems after surgeries, Duke excelled at preventing serious breathing problems and not leaving dangerous objects in patients' bodies, but did worse than average at surgical wounds splitting open, collapsed lungs, dangerous blood clots and accidental cuts and tears. The hospital performed close to the average on deaths from serious, treatable complications after surgeries. 

Duke scored well on four out of five practices to prevent errors—including hand-washing and communication about medicines among staff—and earned high marks on tracking and reducing risks to patients and air embolisms. The hospital scored worse than average, however, on patient falls and dangerous bedsores.

A possible cause for the lowered grade is the intense treatments Duke offers its patients. 

Owens said that Duke Hospital has one of the largest programs in the country for ventricular assist devices—mechanical heart pumps—and is one of the biggest extracorporeal membrane oxygenation institutions in the country. 

“As we were doing more and more of these very, very aggressive treatments for very sick patients, we saw they were having higher rates of infection, which is known because you have many different lines and tubes in the body that perforate the skin and increase the risk of infection,” Owens said. 

From 2016 to 2017, there was a 23 percent reduction in central line infections and a 13 percent reduction in C. diff infections, Owens explained. While these numbers are good, he said they are not good enough.

To reduce the number of C. diff infections—which cause stomach pain and diarrhea—Duke is working on an antibiotic stewardship program to improve the use of antibiotics that prevent C. diff. Employees are also trying to work with the patients and families to help reduce risk of infection, Owens said. Many programs are in place that clean patient rooms with high-intensity ultraviolet light and focus on employee hand-washing, with the goal of an 100 percent hand-washing rate. 

According to Medicare’s Hospital Compare website, which Owens said has more recent data, Duke has shown improvement and is no different than the national average in safety rating.

“[The Centers for Medicare and Medicaid Services] published recent data that showed we’re no different than the national average, but that’s not good enough—we want to be better than the national average,” Owens said. “So we’re doubling our efforts around infection prevention, hand-washing and high-intensity room cleaning.”