Health and Science

Hospitals make 'unprecedented' strides in patient safety

An "unprecedented decline" in the harm suffered by patients during hospital treatment has lead to about 50,000 fewer fatalities and about $12 billion in savings since 2010, the government announced Tuesday.

The steep decrease in so-called "hospital-acquired conditions"—such as infections, adverse drug effects and bedsores—was partly due to Obamacare provisions, officials suggested. They also pointed to public partnership with hospitals that targeted those conditions and aimed to reduce the volume of patients readmitted after treatment.

Overall, there were 1.3 million fewer cases of harm to patients from such conditions from 2010 through 2013—a 17 percent drop, according to a report on patient quality and safety.

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There was a marked increase in patient safety in the later part of the study, "with almost 35,000 of [the] deaths averted" 800,000 fewer incidents overall in 2013, which the report called "a remarkable achievement."

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The report noted that most of the decrease in deaths in 2013 came from a reduction in pressure ulcers, or bedsores, which result from patients being immobile for too long. The study was largely based on a review of thousands of medical records annually, as well as other data,

"Today's results are welcome news for patients and their families," Health and Human Services Secretary Sylvia Burwell said. "These data represent significant progress in improving the quality of care that patients receive while spending our health-care dollars more wisely."

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"HHS will work with partners across the country to continue to build on this progress," Burwell said.

Dr. Patrick Conway, deputy administrator for innovation and quality at the federal Centers for Medicare and Medicaid Services, said that the collaborative efforts between public and private entities to improve patient care "are rapidly moving health-care safety in the right direction."

Preventing ailments

The problems of hospital-acquired conditions has long plagued the health-care sector, leading to unnecessary injury, death and billions of dollars in costs.

The report noted that in 2010, investigators from the inspector general's office of HHS had found that the rate of injuries related to the care of patients was 27 percent among hospitalized patients who were covered by the federal Medicare insurance program. Nearly half of those cases "were considered preventable," according to the new report.

A senior CMS official who briefed reporters in advance of the report said he vividly recalled working as a doctor years ago and hearing an attending physician say, "These things happen," when an infant died from an infection.

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Another agency official said that while such infections once were seen as inevitable, "now they're seen as preventable." Both officials spoke on the condition of not being identified.

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One official said the sharp decreases reported in lives lost, harm done and money spent "are huge numbers."

"This is an uncommon event, which I hope we will appreciate," the official said. "This is an unprecedented decline of patient harm in this country."

Reasons for progress not clear

But the credit for that event is not necessarily clear.

The report pointedly noted: "The reasons for this progress are not fully understood."

However, the report also said there are "likely contributing causes."

Those include the Affordable Care Act, which specifically targets conditions seen as preventable by financially penalizing hospitals that see high rates of readmission of patients on Medicare if they return to the hospital within 30 days with conditions such as heart attacks and pneumonia.

Another tool cited that targets hospital-acquired conditions was HHS's Partnership for Patients initiative. That effort is aiming to reduce preventable conditions by 40 percent compared to 2010 by the end of 2014. The initiative promotes sharing of information between hospitals on the best practices to prevent adverse conditions and promotes efforts to improve the transition of people from in-patient hospitals to other care providers.

"This has been a bold project with significant success, as cited" by the data, said a senior hospital industry representative, who briefed reporters. "We've been working really hard."

Patient advocates were generally pleased with the report, while noting there remains much to be done to lower the number of cases of patient harm further.

"A reduction of 40 percent was ambitious, but 17 percent is still a significant improvement, and we need to continue to work to get to zero harm," said Dr. Tejal Gandhi, president and CEO of the National Patient Safety Foundation.

"For some of the safety issues addressed in this report, such as central-line associated bloodstream infections, there are known best practices, and the reduction is likely a reflection that more hospitals are learning about and adopting these practices," Gandhi said.

She added that "it's also important to note that in addition to making care safe for patients, any improvement in this magnitude is also going to reduce costs of care. Hospital leaders as well as our elected officials should take note of that, and renew their commitment to funding quality and safety programs."

Nancy Berlinger, a research scholar at the Hastings Center, a bioethics research institute, said, "This report offers encouraging news to health-care organizations and to current and future patients."

"Focused efforts to identify the causes of preventable harms to patients, to translate this knowledge into safer ways to deliver health care, and to use policy to support safety and prevent harm, are paying off," Berlinger said. "We now know that the duty to 'do no harm' includes protecting patients from harms created by health care systems."

But, Berlinger added, "we can never rest on our laurels." She said that further steep reductions in patient harm rates is "going to take a very big effort, and a concerted effort."

Berlinger, who is the author of the book "After Harm: Medical Error and Ethics of Forgiveness," said that while hospitals are necessary places for people to get health treatment, "they are risky places," because of the opportunities for infections and other harm.

A patient and their family, she said, "cannot protect the patient against the harms that are being generated by the system. Only the system can do that," she said.

Berlinger also said that the efforts to further reduce the rates of harm may be stymied, in some cases, by the complexity of the health-care system, and by the frequency in which patients are transferred from one institution to another.

"The challenge now will be sustaining this in a time of immense health-care system change," she said. "Hospitals are merging, and there is constant change in our systems."