Louisiana ranked fifth-worst in the United States when it came to patient safety, according a study by ratings firm CareChex.

The study looked at 12 patient safety indicators for avoidable events, including post-operative hip fractures, hemorrhages and respiratory failure.. Those measures were developed by the federal government’s Agency for Healthcare Research and Quality. Delaware, Vermont, Massachusetts and Indiana were the top five states for patient safety. The only states that ranked lower than Louisiana were Kansas, Arkansas, Alaska and Hawaii.