To say the road to improving patient safety in U.S. hospitals is far from finished and filled with potholes is an understatement.
That's despite major ongoing efforts by policymakers and healthcare providers to make improvements—from financial penalties to the sharing of best practices—and protect patients from hospital-acquired conditions and medical errors.
There is agreement that significant progress has been made on some fronts, notably in reducing central-line bloodstream infections and early elective deliveries. But problems remain in many areas, due to a wide range of unproven interventions and inadequate performance metrics. Some clinical leaders doubt hospital safety is much better than it was 15 years ago when the Institute of Medicine issued a landmark report that helped launch the patient-safety movement.
Last week, the Agency for Healthcare Research and Quality reported significant advances. It estimated that approximately 1.3 million fewer patients were harmed in U.S. hospitals between 2010 and 2013. That represents a cumulative 17% reduction, preventing about 50,000 deaths. The estimated 34,530 deaths avoided in 2013 were nearly 10 times more than in 2011, suggesting rapid progress. The estimated three-year cost saving from harm reductions was nearly $12 billion. HHS is expected to publish data this month on hospital-acquired conditions in individual hospitals.
The AHRQ report was based on medical records collected by the CMS as part of Medicare's quality-improvement process, as well as surgical-site infection data from the Centers for Disease Control and Prevention's National Healthcare Safety Network, and adverse obstetric events from AHRQ's Patient Safety Indicators. The review included samples of between 18,000 and 33,000 medical records each year.
The IOM first called attention to the nation's “epidemic of medical errors” with its 1999 report, To Err is Human, which estimated that as many as 98,000 patients die in U.S. hospitals each year because of preventable events. Healthcare was a decade or more behind other high-risk industries in providing basic safety, according to the report.
Healthcare leaders responded by establishing safety-improvement programs. Those efforts were accelerated by the 2010 Patient Protection and Affordable Care Act, which introduced financial penalties for poor quality performance, and launched the Partnership for Patients, a federally funded public-private learning collaborative to enhance safety.
Despite some reports of success, safety experts say improvements have been limited. “It is quite early to take a victory lap,” said Dr. Ashish Jha, a health policy professor at the Harvard School of Public Health. “I don't know if care is safer. It might be, but we have a long way to go.”
Officials from the AHRQ, CMS and American Hospital Association, who presented the report last week, said improvements have come from widespread efforts to reduce adverse drug events, hospital-acquired infections and other errors over the three-year period, particularly through the Partnership for Patients. When it started in April 2011, the partnership aimed to reduce hospital-acquired conditions by 40% and preventable all-cause 30-day readmissions by 20% in 2013 using data from 2010 as a baseline.