Medical Device Daily

Despite the growing emphasis in patient safety programs being implemented at hospitals throughout the U.S., a new report says that patient safety incidents at the nation's hospitals rose 3% over the years 2003 to 2005.

With nearly 5,000 hospitals evaluated, the survey also shows great variation in these incidents, the nation's top-performing hospitals having a 40% lower rate of medical errors when compared with the poorest-performing hospitals.

The report is the largest annual study of patient-safety, according to its sponsor, HealthGrades (Golden, Colorado), an independent healthcare ratings company.

"From our perspective, there are a couple of things that are surprising, but over time, less surprising," Scott Shapiro, VP of corporate communications and marketing, told Medical Device Daily. "The difference between the hospitals that do very well on safety and those that don't continues to be quite large. This finding about the hospitals in the top 5%, having 40% fewer patient safety incidents over those three years, compared with the poorest performing hospitals, is really quite a large number."

• Patient-safety incidents continue to increase in American hospitals, with 1.16 million preventable patient-safety incidents occurring over the three years studied among Medicare patients in the nation's hospitals, a rate of 2.86%.
• 247,662 deaths were potentially preventable over the three years, and Medicare patients who had one or more patient-safety incidents had a one-in-four chance of dying.
• The excess cost to hospitals as a result of these incidents was $8.6 billion over three years, the most common incidents proving to be the most costly.
• 10 of the 16 patient-safety incidents tracked worsened from 2003 to 2005, by an average of almost 12%, while seven incidents improved, on average, by 6%.
• Patient-safety incidents with the greatest increase in incident rates were post-operative sepsis (34.28%), post-operative respiratory failure (18.70%) and infections due to medical care (12.23%).
• Patient-safety incidents with the highest incidence rates were decubitus ulcer, failure to rescue and post-operative respiratory failure.

"The cost of medical errors at American hospitals in both mortality and dollar terms continues to be significant, and the 'chasm in quality' between the nation's top and bottom hospitals, which HealthGrades has documented in this and other studies, remains," said Dr. Samantha Collier, HealthGrades' chief medical officer and primary author of the study. "But the nation's best-performing hospitals are providing benchmarks for the hospital industry, exercising a vigilance that resulted in far fewer in-hospital incidents among the Medicare patients studied."

The Institute of Medicine (Washington) report published in 1999, "To Err Is Human: Building a Safer Health System," found patient safety incidences to be disturbingly high, and led to calls for improvements in quality throughout the system.

Shapiro said that in light of such studies, HealthGrades would have expected greater improvement, given the broad dissemination of the data, in addition to a recent focus in hospitals on "failure to rescue."

"Certainly something that we see in this study as declining is the number of incidents related to failure to rescue, and we can surmise that this is the result of rapid response teams and other efforts that many hospitals are putting into place," he said.

The fourth annual HealthGrades Patient Safety in American Hospitals Study applies methodology developed by the Agency for Healthcare Research and Quality (Washington) of the Department of Health and Human Services to identify the incident rates of 13 patient safety incidents among Medicare patients at virtually all of the nation's nearly 5,000 non-federal hospitals. Additionally, HealthGrades applied its methodology to identify the best-performing hospitals, or Distinguished Hospitals for Patient Safety, representing the top 5% of all U.S. hospitals.

Following are the 16 patient-safety incidents studied:

• Accidental puncture or laceration
• Complications of anesthesia
• Death in low-mortality DRGs
• Decubitus ulcer
• Failure to rescue
• Foreign body left in during procedure
• Iatrogenic pneumothorax
• Selected infections due to medical care
• Post-operative hemorrhage or hematoma
• Post-operative hip fracture
• Post-operative physiologic metabolic derangement
• Post-operative pulmonary embolism or DVT
• Post-operative respiratory failure
• Post-operative sepsis
• Post-operative abdominal wound dehiscence
• Transfusion reaction

The HealthGrades study identified 242 hospitals —those in the top 5% of all hospitals — to serve as a benchmark against which other hospitals can be evaluated, calling them Distinguished Hospitals for Patient Safety.

On average, HealthGrades said, those hospitals had a 40% lower rate of patient-safety incidents when compared with the poorest-performing hospitals. If all hospitals performed at the level of the Distinguished Hospitals for Patient Safety, the study found that about 206,286 patient-safety incidents and 34,393 Medicare deaths could have been avoided; and $1.74 billion could have been saved.

To be ranked in overall patient-safety performance, hospitals had to be rated in at least 19 of the 28 procedures and diagnoses rated by HealthGrades and have a current overall HealthGrades star rating of at least 2.5 out of 5. The final ranking set included 752 teaching hospitals and 857 non-teaching hospitals. The top 15%, or 242 hospitals, were identified as Distinguished Hospitals for Patient Safety, and represent less than 5% of all U.S. hospitals examined in the study.

Shapiro said that reports and data generated by HealthGrades are used by a range of corporate entities, institutions and consumers, with about 3 million consumers visiting its web site each month to get comparison data for healthcare providers. It says it provides profiles of hospitals, nursing homes and physicians.

"Certainly, changes in processes and procedures is not something that happens overnight," he said. "We would guess that we will see those declines in future studies, but we would have liked to have started seeing them this year."