About 2.1 million fewer patients were harmed in hospitals from infections, adverse drug events and other conditions between 2010 and 2014, federal officials said Tuesday. The progress on hospital-acquired conditions, they said, averted $19.8 billion in associated costs and 87,000 deaths.
“These results represent real people who did not die or suffer harm,” said Dr. Patrick Conway, chief medical officer for the CMS.
The new report updates federal estimates released last December. While experts agree hospitals have made significant progress, safety leaders also remain concerned about the proliferation of unproven interventions and inadequate performance metrics.
Federal officials acknowledged those concerns on Tuesday and pointed out that improvements tallied in the report were not equal across all categories of patient harm.
For example, while a 72% reduction in rates of central-line associated bloodstream infections saved the nation an estimated $221 million during the four year window, no improvements were seen in areas such a ventilator-associated pneumonia (VAP) and patient falls.
The answer to why the needle has not moved on preventing falls remains unclear, said Richard Kronick, director of the Agency for Healthcare Research and Quality. “But a reasonable hypothesis might be that patients were moving more—which is a good thing—but moving also increases exposure to falls.”
Hospitals and federal agencies have increased attention to VAP in recent years. Still, some have said the definition of the condition is subjective, making it difficult for clinicians to appropriately identify it.
While there is still a long way to go, the CMS, the AHRQ and the American Hospital Association assert the efforts to improve quality in U.S. hospitals are paying off. The report noted improvements in reducing adverse drug events, catheter-associated urinary tract infections and pressure ulcers.
The AHRQ concedes in the report that the "precise causes of the decline in patient harm are not fully understood."
It adds, however, that the successes were achieved during a period of focused efforts that include payment models that reward performance on quality measures, widespread implementation of electronic health records, and the sharing of best practices through hospital engagement networks under the Partnership for Patients, a public-private initiative launched in 2011.