Hospitals Show Small Improvement in Patient Safety

Last week’s report from the Centers for Medicare & Medicaid Services (CMS, or Medicare), was good news for monitors of two thorny problems associated with being in the hospital – the high incidence of injury, and the large numbers of “bounce backs” — readmissions within 30 days of discharge.

As explained on KaiserHealthNews.org (KHN), the improvement is at least partly due to new federal laws that financially penalize health-care facilities that fall below certain standards. But they’re also the result of measures implemented before the law as a response to the increasing awareness of how lax hospital procedures and uncoordinated care contribute to errors.

According to the CMS report, incidents of patient harm in the hospital dropped from 145 complications per 1,000 hospital discharges in 2010 to 132 complications per 1,000 discharges in 2012. “Incidents” were such things as infections, trauma during vaginal births, reactions to medicines, falls and bedsores. A total of 28 measures were used in the estimates by the federal Agency for Healthcare Research and Quality.

In a news release, the Department of Health and Human Services said, “National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries and approximately $4 billion …”

In terms of readmissions, the number of Medicare patients who were re-hospitalized within 30 days of discharge decreased from 18.5 in 100 in 2012 to 17.5 in 100 in 2013. That pencils out to about 150,000 fewer readmissions over the last two years. Many hospitals have addressed the problem by improving their discharge procedures and monitoring patients better after they leave.

More than 2,000 hospitals, according to KHN, have been fined each of the last two years because the number of patients they had to readmit within 30 days was higher than the health law standard.

Still, there’s a way to go to achieve anything close to a comfort level with hospital-induced harm – 1 out of 8 patients is injured while hospitalized. (See our blog, “Protecting Yourself from the Thousand-a-Day Toll of Medical Error.”)

Dr. Kevin Kavanagh, chairman of the consumer advocate group Health Watch USA, told KHN that improvement is welcome, but that the reduction in patient safety problems “is a small change” relative to how often patients are still being hurt.

One measure that should help there takes effect in October, when, in addition to the existing Medicare quality bonus and penalty program, penalties for infections can be imposed.

Leah Binder, president of The Leapfrog Group, a health-care quality assessment organization we have written about, faulted the government for not reporting rates for individual hospitals. “With due respect to the hard work of our CMS colleagues,” she told KHN in an email, “their report sounds exciting, but it’s not helpful to families that want to protect themselves from getting killed by a hospital error – and that’s simply unacceptable.”

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