The Leapfrog Hospital Survey, which annually compares hospital performance on standards of safety, quality and efficiency, added 45 hospitals to the highest ranking of quality care this year.

The study of almost 1,300 hospitals in 37 geographical areas named 34 urban, eight children’s and three rural hospitals to the top of the ranks.

The online survey measured key indicators such as mortality rates, rates of infection, safety practices and efficiency measures at all participating facilities.

In its eighth annual survey, Leapfrog-- in addition to recognizing urban hospitals--also acclaimed the effectiveness of three rural hospitals: the Polk Medical Center in Cedartown, Ga., Stephens Memorial Hospital in Norway, Maine, and the Waldo County General Hospital in Belfast, Maine.

"Rural hospitals deserve special recognition as they often have higher hurdles to clear than their larger, urban counterparts in terms of access to capital and other resources," said Leah Binder, CEO of The Leapfrog Group.

Overall, the top ranked urban hospitals (available here) in regards to Leapfrog criteria have:

• Met standards for computer physician order entry (CPOE) systems;
• Met performance standards for high-risk procedures, such as heart bypass surgery;
• Met standards for ICU staffing; and
• Score in the top ranks in the U.S. for efficiency by quality outcomes including, length of stays, readmission rates and hospital incidence (in reference to heart bypass surgery, heart angioplasty, heart attack and pneumonia patients).

According to the results, the 2009 top urban hospitals are dispersed throughout 13 states—Arizona, California, Illinois, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, Ohio, Pennsylvania, South Carolina, Tennessee and Washington.

"This year's class of top hospitals not only hits the mark in areas such as medication error prevention and preventing ICU deaths, but they also use their resources wisely, providing excellent and efficient outcomes for patients," said Binder, a former administrator of a rural hospital. "Regardless of what happens to healthcare reform, these hospitals are the future."