Delaware dropped from 29th to 49th in the fall 2021 Leapfrog Safety Grades report as two of the state’s major hospitals went from an “A” to a “C.”

The Leapfrog Group assesses how well hospitals in the 50 states and the District of Columbia prevent medical errors, falls, infections and accidents, according to a news release from the nonprofit organization. The hospitals are given a letter grade and the states are ranked according to the grade. The safety reports are released in the fall and spring of each year.

Only one other state, North Dakota, and the District of Columbia had no hospitals with an “A” score.

The Christiana Care Health System’s two hospitals received “A” grades in the spring but they were dropped to “Cs” in the latest report. The health care system’s hospital in Christiana received low marks for problems with surgery and harmful events afterward.

The Christiana hospital received high grades in a new safety measure evaluated by Leapfrog, “sepsis infection after surgery.” Sepsis is responsible for the deaths of 270,000 people a year with 160,000 of them attributed to postoperative sepsis, according to Leapfrog.

The Christiana Care Health System’s Wilmington location also received low marks for problems with surgery and complications after the surgery including kidney injuries. The hospital received high marks for infection control with the exception of surgical site infections that occur after colon surgeries.

Two other state hospitals, Bayhealth Kent Campus in Dover and Wilmington’s Saint Francis Hospital, also received “C” grades. Beebe Healthcare in Lewes and Tidal Health Nanticoke in Dover received “B” grades.

The fall 2021 safety survey is Leapfrog’s largest, with 2,901 hospitals receiving grades, according to the organization. The grades are compiled by leading safety experts with guidance from the Johns Hopkins Armstrong Institute for Patient Safety and Quality.

“As the pandemic continues, we all have heightened awareness of the importance of hospitals in our communities and in our lives,” said Leah Binder, president & CEO of The Leapfrog Group. “It is critical that all hospitals put patient safety first. Now we have more information on more hospitals than ever before, so people can protect themselves and their families.”

Less than 1% of the hospitals received an “F” and 32% received an “A,” according to Leapfrog. Virginia, North Carolina, Idaho, Massachusetts and Colorado have the highest number of hospitals with “A” grades.