The number of adverse patient-safety incidents is increasing in the nation's hospitals as a group, while the gap is widening between the best-performing hospitals and the worst-performing hospitals, according to a study released today.
The study of 38.6 million hospitalizations from 2001 through 2003, performed by scorecard company HealthGrades, of Golden, Colo., relied on Medicare Provider Analysis and Review data from Medicare patients at nearly 5,000 hospitals. According to the results, the best performers reduced the number of such safety incidents, while the worst ones saw the number of such incidents increase.
Overall, problems in 16 patient-safety areas that were measured accounted for an estimated $8.73 billion in excess inpatient costs to Medicare during the three-year study period.
Researchers for HealthGrades' Second Annual Patient Safety in American Hospitals Report looked at indicators identified by the federal Agency of Healthcare Research and Quality for use in screening administrative data for patient-safety concerns. They included both general care problems such as failure to rescue, pressure sores or infections as a result of medical care, and post-operative complications such as sepsis, wound reopening or pulmonary embolism/deep vein thrombosis.
Failure to rescue, pressure sores and post-operative sepsis were the three most prevalent problems, accounting for 62% of all patient-safety incidents found by the study. The three most expensive incidents, in terms of adding to the cost of care, were pressure sores, at $2.77 billion; infections from medical care, at $1.9 billion; and post-operative pulmonary embolism/deep vein thrombosis, at $1.21 billion, for the three-year period studied.
"Definitely, the good news is, the two death indicators -- failure to rescue and death in low-mortality DRGs -- as well as general mortality overall in Medicare, has declined," said study author Samantha Collier, a physician and vice president of medical affairs at HealthGrades.
But the data also show an 11.3% increase in the number of Medicare patient-safety incidents from 2001 to 2003, compared with a 4.9% increase in the number of Medicare hospitalizations. Collier said the increase could be explained in part by better detection and reporting of problems.
The 25-page study also suggests that in the more than five years since the oft-cited Institute of Medicine report, To Err is Human, was issued, despite "a proliferation of patient-safety improvement programs," those efforts "have not achieved the report's (minimum) goal of reducing medical errors by 50% in five years."
On the contrary, there were 1.14 million incidents reported for Medicare patient hospitalizations between 2000 and 2002, according to HealthGrades, and 1.18 million incidents between 2001 and 2003, the period covered by the current study.
During the more recent period, 298,865 Medicare patients who had developed one or more of the highlighted safety incidents died, according to the report. Of those, 241,280 deaths were directly attributable to patient-safety incidents.
There was little variance in patient-safety performance among regions of the country, but there was considerable variance among hospitals, according to the report. The top 10% of hospitals, which were ranked by HealthGrades on 13 of the 16 measures studied, "significantly outperformed the bottom 10% ... on overall patient-safety performance."
More pointedly, the report noted that if the hospitals in the bottom 10% improved only their rates for hospital-acquired infections to the level of the hospitals in the top 10%, there would have been more than 2,700 fewer infection-related deaths and an additional $792 million would have been saved.
"We anticipate that the performance gap between the top 10% and the bottom 10% will continue to widen without appropriate incentives," the report suggested.