Safety in Hospitals?
April 19, 2011
Safety troubles on the rise since “To Err is Human”
Has it really been 12 years since the Institute of Medicine released this report?
A study released in November of 2010 showed that one in three hospital patients experience adverse events and about 7% are harmed permanently or die as a result.
This study, published in April’s Health Affairs, was taken from two reports that showed rates of adverse events near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.
The study showed research estimating that up to 98,000 patients die each year due to preventable medical errors.
From a survey released March 31, patients are scared of medical mishaps. Almost 60% of adults polled by the Consumer Reports National Research Center feel that medical errors are common in hospitals, and nearly half said serious harm is common. Almost 80% of patients said they were afraid of contracting an infection in a hospital, 71% were worried about medication errors and 65% were scared of surgical mistakes.
Patient safety improvement remains uneven, said Mark R. Chassin, MD, president of the Joint Commission, which is the accreditation organization for hospitals and other health care organizations.
“What we have been doing for the last 10 or 15 years has produced some important progress, but it has not produced the kind of improvement that anybody wants to see. The progress is not broad enough across the different services that are delivered in health care, and it’s not consistent within health care, whether at physician practices, hospitals or facilities of any sort. And it’s not deep enough,” he said.
According to Dr. Chassin, who co-wrote a separate article in the April Health Affairs, said physicians and hospitals should look to “high-reliability industries” such as commercial aviation to develop processes that identify systemic weaknesses before they result in harm.
A report being prepared by The American Medical Association’s new Center for Patient Safety will speak to the last decade of research in ambulatory patient safety. The report will be released this year and will focus on how organized medicine can help office-based practices improve quality in areas such as hospital readmissions.
The vast majority (93%) of the adverse events identified in the Health Affairs study required medical intervention but did not permanently injure or kill the patient. Most of them were medication-related or hospital-acquired infections. This study did not attempt to estimate how many of the adverse events could have been prevented.
The NEJM study said 63% of the adverse events that reviewers identified could have been avoided. A November 2010 report from the Dept. of Health and Human Services’ Office of Inspector General for Medicare patients estimated that 44% were preventable.
HHS Secretary Kathleen Sebelius announced on April 12 that the “Partnership for Patients” initiative is aimed at preventing 60,000 health care-related deaths and avoiding $50 billion in Medicare costs over 10 years.
The program will disburse $1 billion under the Patient Protection and Affordable Care Act to reduce hospital readmissions and cut hospital-acquired conditions such as pressure ulcers and catheter-related urinary tract infections.
Also in April (over objections from the American Hospital Assn.), the Centers for Medicare & Medicaid Services began reporting individual hospital performance on hospital-acquired conditions at its Hospital Compare website.
And yet…nurses are still overworked to the point of the impossible in terms of workload and accountability through documentation. Nursing organizations such as the ANA are working through legislative efforts to help correct the nurse/patient ratios so that the ones at the bedside can have the time and energy that it takes to care for patients holistically, provide simple comfort measures and most importantly, avoid errors.
There is a better future ahead. The key, in my opinion, has always been and will always be more nurses – with better incentives for new nurses to learn, and likewise for the more advanced nurses to be able to share the wealth of their time and experience. Quality personnel, time, and pay scales can turn this mess around.