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Chip Kahn, president of the Federation of American Hospitals

Patient safety is improving, has changed from 15 years ago, hospital groups contend

By Sabriya Rice
Posted: July 18, 2014 - 3:00 pm ET

Groups representing U.S. hospitals took issue with statements made at a recent Senate hearing that patient safety has not improved in the past 15 years. The hearing did not paint a clear picture of the improvements that have been made to address preventable harms, such as wrong-site surgeries and hospital-acquired infections, hospital groups contend.

Nationally representative data may be limited, the hospital associations say, but the data that does exist shows improvement.

During a Senate Subcommittee on Primary Health and Aging hearing this week, a panel of patient-safety leaders expressed concern that 15 years after the eye-opening Institute of Medicine report “To Err is Human” (PDF) highlighted the issue of hospitalized patients being harmed or dying because of preventable errors, improvement has been limited, sporadic and inconsistent. Subcommittee chairman Sen. Bernie Sanders pointed to a 2013 study, which estimated the number of premature deaths associated with preventable harm may be four times higher than previous estimates.

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Groups representing U.S. hospitals responded Friday saying that data does exist on improvements, and that estimates showing as many as 400,000 preventable harms occur each year may be misleading.

“You have to question the baseline and how good was the data that provided that baseline,” said Chip Kahn, president of the Federation of American Hospitals, which represents managed community hospitals and health systems. Data collection is better today than it was in the past, and there are various new safety points that can be measured, including mistakes that are caught before a patient is harmed, he said. The new research “does not reflect the reality of care in the hospital today, much less 15 years ago,” Kahn commented.

Hospitals have “focused like a laser beam” on quality and safety improvements, according to the American Hospital Association. To imply there has been no progress ignores what the data show, an AHA statement said.

“There's limited data, but on the measures where nationally representative data is collected it's easy to point to advances,” said Nancy Foster, the AHA's vice president for quality and patient safety policy, in a phone call.

She pointed to central line blood stream infections, which were also mentioned as an area of great improvement by panelists in Thursday's hearing. She also noted progress with early-elective deliveries and patient falls.

Part of the struggle, Foster said, is that there are no solutions that work universally. Individually and through collaborations, hospitals have been adopting best practices for specific problems and these efforts result in non-events, she says. “It's hard to create that picture effectively for the public,” she said.

Patient-safety experts also emphasized this week the need for more reliable data, metrics and monitoring systems that can consistently provide accurate comparisons on outcomes. But Foster says too much emphasis on data collection can send the wrong message. “It would be misleading to think that simply creating a data set is going to magically create patient safety,” she said. Data are an essential part, she said, but must be coupled with clear information on what drives the safety events.

Safety advocates agree progress is being made, but say without a clearer national picture, it is hard to develop highly reliable systems that deliver consistent care to every patient. They called for more accountability, incentives to encourage safety and the need for federal legislation or policy to encourage change.

“It's like we're fixing pieces of a car,” said Rosemary Gibson, senior advisor art the Hastings Center. “We're good at fixing individual parts, but is the car safe overall? We're so far from that,” she said. A deep reluctance exists to count the number of patients harmed and events are often underreported, she noted. “In the absence of that, we're left with estimates,” said Gibson, who supports recommendations for a publically reported tracking system.

Patient-safety leaders and hospital groups agree, however, that accountability is needed and that public policy can help.

Hospitals already have started to feel the weight of heavy penalties through efforts by the CMS, and through the Joint Commission, which accredits them, Kahn said. But policy can help ensure broad adoption of all the aspects of quality known to work.

“Any hospital CEO who hasn't adopted them is clearly going to get the message through policy,” he said.

Follow Sabriya Rice on Twitter: @MHSRice

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