A report issued last week by the U.S. Department of Health and Human Services (HHS) was a good news-bad news portrait of hospital care in America.
The report showed that between 2010 and 2013, 50,000 fewer patients died in hospitals and about $12 billion in health-care costs were saved as a result of reduced hospital-acquired conditions (HACs). The HHS report says that progress toward a safer health-care system reflects a better effort by hospitals to reduce the numbers of adverse events.
For a long time, hospitalized patients have been harmed by an unacceptably high rate of problems, including hospital-acquired infections (HAIs).
Patients can contract such infections, as we’ve explained in previous blogs, during surgery, from poor management of IVs and catheters and deficient hygiene by hospital staff. Improved safety, the feds say, has resulted in 1.3 million fewer harms overall to hospital patients.
An HHS official, as quoted by MedPageToday, said, “The 17% reduction … indicates that hospitals have made very substantial progress in improving safety. We can’t precisely determine causality but [the decrease] occurred during a concerted effort by hospitals to reduce adverse events. Financial incentives by payers, public reporting of results and technical assistance offered by quality improvement organizations … all contributed to these impressive results.”
The report reviewed as many as 33,000 medical records each year from the Inpatient Quality Reporting Program at the Centers for Medicare and Medicaid Services (CMS). The report’s improvements included:
- a 19% drop in adverse drug events;
- a 28% decline in catheter-associated urinary tract infections;
- a 49% decrease in central line-associated bloodstream infections;
- a 20% drop in pressure ulcers; and
- an 18% decrease in postoperative venous thromboembolisms (blood clots).
The report acknowledged that although things have improved, no one should be satisfied. “The 2013 HAC rate of 121 HACs per 1,000 discharges means that almost 10 percent of hospitalized patients experienced one or more of the HACs we measured. That rate is still too high,” the authors wrote.
Examples of adverse events that could have and should have been avoided aren’t hard find. Last week, the Boston Globe reminded readers about the case of Betsy Lehman, a 39-year-old woman who had been undergoing breast cancer treatment at a prestigious Boston cancer center in 1994 and was administered four times as much of a chemotherapy drug as she was supposed to have. It killed her. The “adverse drug event” led to the creation of the Betsy Lehman Center for Patient Safety and Medical Error Reduction.
“But two decades later,” The Globe reported, “nearly one-quarter of Massachusetts residents say they, or someone close to them, experienced a mistake in their medical care during the past five years, according to a survey released Tuesday. And about half of those who reported a mistake said the error resulted in serious health consequences.”
Sadly, the survey of more than 1,200 people by the Harvard School of Public Health found that many respondents did not report the medical mistakes, “often because they did not believe it would do any good, or they did not know how to report it.”
Robert Blendon, the survey’s director, told The Globe, “When you are trying to reduce incidents, and 20 years later you still have a significant number of people who report a significant event, it sets off concerns.”
The poll was commissioned by the Lehman center. Its mission is to improve quality and reduce health-care costs. It’s an independent agency within the state’s Center for Health Information and Analysis, and is funded through fees assessed on hospitals and insurers.
Collecting patient safety and patient harm data is challenging. Most data collected and reported in Massachusetts regarding serious medical errors come from acute-care hospitals and surgical centers. Changes in how statistics are compiled make it hard to pinpoint whether patient safety has improved or not, according to The Globe.
That’s what prompted the Harvard survey as well as two others. A study by the National Academy for State Health Policy showed that although 26 states have systems to monitor adverse medical events, their number has not increased since 2007.
And although these systems can provide valuable information, defining overall trends in patient safety is limited, the newspaper explained, because most states haven’t integrated their monitoring systems into broader initiatives to improve quality and reduce medical costs.
So although we applaud what the federal government says is progress on the patient safety front, there’s still a long way to go before we even know the scope of the problem, much less how to fix it.