Alabama ranks 39th among the 50 states and the District of Columbia in the fall 2021 Leapfrog Hospital Safety Grade, dropping from 37th in the organization’s spring report.

Leapfrog, a nonprofit watchdog, impanels a nationwide group of safety experts twice a year and measures hospitals on safety measures ranging from falls to infections. The ratings this year include postoperative blood infections, kidney injuries and sepsis, which the organization said is responsible for 160,000 postoperative deaths each year.

Thirteen of the 68 Alabama hospitals, or 19.4%, received A grades. According to the report, 20.4% of the state’s hospitals received A grades in the spring. No hospitals received an F grade and only five received a D grade.

Nationwide, 32% of hospitals an earned an A grade, 26% received a B, 35% received a C and 7% received a D, according to Leapfrog. Less than 1% received an F grade.

Massachusetts, Virginia, North Carolina, Idaho and Colorado had the highest percentages A grades. Fewer than 1% of hospitals in the U.S. received an F grade with 32% receiving A grades, according to the report. Delaware, the District of Columbia and North Dakota tied for last place.

The report includes 2,901 hospitals, the largest yet to be included in the reports from Leapfrog.

The findings come at a time when the COVID-19 pandemic has increased consumer interest in hospital safety, according to Leah Binder, president and CEO of The Leapfrog Group.

“As the pandemic continues, we all have heightened awareness of the importance of hospitals in our communities and in our lives,” Binder said in a news release. “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.”