According to the National Institutes of Health, nearly 50,000 to 100,000 patients die in U.S. hospitals each year as the result of lapses in safety. Recently, the Leapfrog Group, a nonprofit promoting transparency and safety in hospitals, released its first-ever Hospital Safety Score. The study analyzed data from 2,652 hospitals from across the country based on 26 different safety-related measures. Each hospital received a score of A, B or C. Grades for hospitals receiving D and F have not yet been finalized.

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Some states have much safer hospital systems than others. In several states, 40% or more of reporting hospitals received the best possible score. In others, not one hospital scored better than a B. Based on Leapfrog’s report, 24/7 Wall St. identified the states with the largest percentage of hospitals receiving an A.

In an interview with 24/7 Wall St., Melissa Danforth, Interim Senior Director of Leapfrog’s Hospital Ratings, explained the importance of the report compared to other national hospital rankings. “The Hospital Safety Score is unique,” according to Danforth, because Leapfrog only considers what puts a patient’s safety at risk, instead of “looking at the reputation of the hospital.” Danforth said, “We’re really looking to, and wanting to draw attention to, things that could happen to you in a hospital that could kill you.”

Danforth explained that hospitals that received an A grade tended to have close to perfect scores for particular safety measures. Incidence of patient falls, trauma, including broken bones or injuries that occur during a patient’s stay, and the likelihood of receiving a central-line associated bloodstream infection (CABSI) — a dangerous infection that can occur during certain procedures — are particularly low among the safest hospitals.

Similarly, the states with the highest percentage of hospitals receiving an A performed better on these important measures compared to the national average. For most of the states on this list, incidents of falls, trauma and CABSIs are below the national average. In Massachusetts, one of the states with the safest hospitals, incidence of particularly bad bedsores — another critical safety measure — is one-third the national rate.

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States with the healthiest hospitals do not necessarily have healthy populations. In addition to the safety scores provided by Leapfrog, 24/7 Wall St. also considered a variety of health-related metrics from statehealthfacts.org, part of The Henry J. Kaiser Family Foundation. Life expectancy, incidence of cancer and diabetes, and heart disease mortality rates were no better in the states with the safest hospitals than the national average.

These are the states with the safest hospitals.

10. Minnesota
> Hospitals with A grade: 37%
> Number of hospitals with A grade: 17
> Life expectancy at birth: 80.85 years
> Cancer death rate per 100,000: 173.7

More than one-third of Minnesota hospitals received an A grade by Leapfrog’s Hospital Safety Score. The state’s hospitals were especially successful at minimizing errors that could potentially occur during inpatient care. For all four criteria used by Leapfrog in assessing life-threatening hospital errors, Minnesota hospitals averaged fewer errors per 1,000 people than the nation’s average. The Mayo Clinic in Rochester, one of the facilities receiving an A, outperformed national averages in all patient safety indicators (PSIs) dealing with surgery, procedures and childbirth.

9. Delaware
> Hospitals with A grade: 40%
> Number of hospitals with A grade: 2
> Life expectancy at birth: 78.32 years
> Cancer death rate per 100,000: 198.4

Out of the five Delaware hospitals reviewed by Leapfrog, two received an A. The Beebe Medical Center in Lewes and Christiana Hospital in Newark have low levels of falls and traumas. This is in contrast to other hospitals in the state where rates of patients falling are more than double the national average. All five reporting Delaware hospitals have fewer patients who suffer postsurgical wound splits than the national average.

8. California
> Hospitals with A grade: 41%
> Number of hospitals with A grade: 97
> Life expectancy at birth: 80.37 years
> Cancer death rate per 100,000: 166.9

Leapfrog reviewed 238 California hospitals — more than any other state in the country. The hospitals measured averaged 0.44 trauma and falls per 1,000 patients, which is lower than the national average of 0.57. One of the state’s Orange County hospitals, St. Joseph, has a rate of death of just  67.5 for every 1,000 serious treatable complications stemming from surgery. This makes St. Joseph one of the best in the country in this measure. Also, the state has 66 separate hospitals that recorded no serious falls or trauma during hospital stays.

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7. Michigan
> Hospitals with A grade: 44%
> Number of hospitals with A grade: 34
> Life expectancy at birth: 77.89 years
> Cancer death rate per 100,000: 191

Hospitals in the state of Michigan generally do a good job keeping patients safe. Cumulatively, these hospitals limited serious incidents of foreign objects left inside patients after surgery, air embolisms, pressure related ulcers, as well as falls and other traumatic injuries. Of the hospitals in the state that scored an A, 15 fully met Leapfrog’s standards for effective ICU staffing and received perfect scores in the survey for hospital leadership, mitigation of risk, quality of the nursing workforce and hand hygiene.

6. Virginia
> Hospitals with A grade: 44%
> Number of hospitals with A grade: 24
> Life expectancy at birth: 78.53 years
> Cancer death rate per 100,000: 188.6

Virginia hospitals have lower rates of accidental cuts or tears from medical treatment than the U.S. average. Virginia hospitals are also better at preventing death from serious treatable complications after surgery, with a rate that is substantially lower than the national average. Hospitals in Virginia have low averages of foreign object retention after surgery and pressure ulcers, also known as bedsores.

5. Tennessee
> Hospitals with A grade: 48%
> Number of hospitals with A grade: 31
> Life expectancy at birth: 76.2 years
> Cancer death rate per 100,000: 206

With higher rates of cancer death and infant mortality than any other state on this list, as well a lower life expectancy, Tennessee needs hospitals that are both good and safe. Fortunately, 48% of the state’s hospitals receive A grades from Leapfrog, while only about 33% of hospitals receive C grades. For all of Leapfrog’s safe practice measures, Tennessee’s hospitals receive above-average score. One hospital performing especially well is Vanderbilt University Hospital, which received high scores for its surgery-related antibiotic regimens, as well as for its handling of urinary catheters and prevention of blood clots following surgery.

4. Illinois
> Hospitals with A grade: 48%
> Number of hospitals with A grade: 51
> Life expectancy at birth: 78.76 years
> Cancer death rate per 100,000: 191.3

Leapfrog surveyed 106 Illinois hospitals. While nearly half received an A grade, the reviewed state hospitals actually performed worse than the national average on many of the key safety metrics, including the frequency of central-line associated bloodstream infections. However, in many other measures Illinois hospitals performed well, including having a low average of the number of deaths from treatable medical complications after surgery. However, many of the state’s 51 hospitals that received an A scored much better than the national average in preventable deaths and ulcers.

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3. Vermont
> Hospitals with A grade: 50%
> Number of hospitals with A grade: 3
> Life expectancy at birth: 79.7 years
> Cancer death rate per 100,000: 179.7

Though only six Vermont hospitals reported information to Leapfrog, three of these earned A grades. Brattleboro Memorial Hospital received above-average ratings for all Surgical Care Improvement Project (SCIP) measures. The hospital also recorded perfect scores in preventing complications related to air embolisms and pressure ulcers. Southwestern Vermont Medical Center and Central Vermont Medical Center similarly recorded a strong performance, with each receiving above-average SCIP ratings. The quality of medical care in the state may well have major benefits for its residents as heart diseases resulted in just 138 deaths per 100,000 people, far less than the nationwide average of 186.5 deaths.

2. Maine
> Hospitals with A grade: 74%
> Number of hospitals with A grade: 14
> Life expectancy at birth: 78.68 years
> Cancer death rate per 100,000: 199.7

Citizens of Maine have lower levels of death as a result of heart disease — 12 percentage points lower than the national average — but a higher rate of deaths from cancer than the U.S. average. After surgery, patients in Maine hospitals are less likely to experience breathing difficulties or respiratory failure than they would in the average hospital in the United States. All of the 19 Maine hospitals reporting averaged exceptional scores in hand hygiene and care for patients on ventilators. Only three of the state’s 19 graded hospitals received a C.

1. Massachusetts
> Hospitals with A grade: 76%
> Number of hospitals with A grade: 47
> Life expectancy at birth: 80.1 years
> Cancer death rate per 100,000: 186.6

Massachusetts has one of the healthiest populations in the country. Average life expectancy from birth in the state is 80.1 years, the sixth-highest in the country. The state also has one of the best — and most expensive — medical systems in the country. The state’s university system produces some of the most prestigious hospitals in the country. More than three-quarters of the state’s hospitals in Leapfrog’s survey received A grades. Just 20 of the of the state’s 62 reporting hospitals failed to record spotless records for pressure ulcers, and two-thirds had a better-than-average percentage of patients receiving the correct type of antibiotics.

-Michael B. Sauter, Alexander E. M. Hess and Lisa A. Nelson

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