Although injuries during hospitalization are recognized as a major hazard in the healthcare system, little is known about their effective prevention. A new study released last week by the Agency for Healthcare Research and Quality lends more credence to some common-sense conclusions others previously had drawn about the problem.
The study, which appeared in the Oct. 8 Journal of the American Medical Association, estimated that medical injuries resulted in an estimated 32,591 patient deaths, $4.6 billion in additional national healthcare costs and 2.4 million extra days of hospitalization in 2000. It follows the landmark report in 1999 by the Institute of Medicine that concluded medical injuries account for 44,000 to 98,000 patient deaths and $17 billion in direct healthcare costs annually.
"The IOM report put up a huge number, but it didn't really take you back behind those numbers in any detailed way," said Richard Wade, spokesman for the American Hospital Association. "This does and it's important."
While the AHRQ study adds little to the scant knowledge about the national prevalence of various types of medical injuries, it provides significant insights into the adverse effects of selected medical injuries on patients and healthcare resources, said its authors. Researchers Chunliu Zhan of the AHRQ, Rockville, Md., and Marlene Miller of Johns Hopkins University, Baltimore, analyzed 18 specific medical complications resulting from failure in hospital care.
The study analyzes excess charges, lengths of stay and mortality among inpatients who had one of 18 defined patient-safety indicators or diagnoses. The 18 measures are among 20 patient-safety indicators developed with AHRQ support to provide a perspective on patient-safety events using hospital administrative data. The indicators are a software tool the AHRQ distributes for free, and they can be used to help hospitals identify potential adverse events that might need further study.
"Medical injuries can have a devastating impact on the healthcare system," Zhan said. "We need more research to identify why these injuries occur and find ways to prevent them from happening."
According to the study, postoperative bloodstream infections had the most serious consequences, resulting in hospital stays that were extended an average of nearly 11 days, added charges of $57,727 per patient and increased patients' risk of death 21.9%. Based on the data, researchers estimate roughly 3,000 deaths per year from postoperative bloodstream infections. The next most serious event was postoperative reopening of a surgical incision, which increased risk of death 9.6%, or caused an estimated 405 deaths annually, while adding 9.4 days per stay and $40,323 in charges per case. In contrast, birth and obstetric trauma resulted in little or no added cost, length of stay or risk of death although it was much more prevalent, the researchers said.
AHRQ Director Carolyn Clancy said the study provides, for the first time, specific estimates for excess charges, lengths of stay and risk of death for 18 of the 20 AHRQ patient-safety indicators.
It is based on medical injury data from 7.5 million hospital discharges from 994 acute-care hospitals in 28 states in 2000. This approximates a 20% sample of nonfederal acute-care hospitals in the U.S. Clancy said the data are more recent than what was published in the IOM report, which was based on medical records.
Many studies have relied on medical records from hospitals to measure excess costs, lengths of stay and mortality, including the well-known Harvard Medical Practice Study, which used the data to estimate deaths and total healthcare costs attributable to medical injuries in Colorado, New York and Utah.
"Besides trying to read handwriting, one of the big problems with medical record review is that the documentation is often incomplete, and it's expensive and resource intensive to do," she said. "The nice thing about these (safety indicators) is, although they measure a subset of all injuries, they come with very easy software so that any hospital could start using them tomorrow."
Wade said the AHA hopes the study will be used widely in hospitals. "Not only for them to look at their own similar data, but I think more than that, it tells us what this is all about in terms of saving lives."