According to a recent report, a quarter of Medicare patients were harmed during a short stay in an acute care hospital in 2018, a figure that was largely unchanged from a decade earlier.
The study, conducted by the Office of the Inspector General of the Department of Health and Human Services, looked at a sample of 770 Medicare patients out of approximately 1 million who were inpatients at 629 hospitals nationwide in October 2018.
Here are five highlights from the patient harm report:
1. Types of harm. The OIG found that while they are not always due to negligence or poor quality of care, cases of patient harm can often be caused by medical errors and poor medical care in general. Of the harms studied, 43% were related to medication, 23% to patient care, 22% to procedures and surgeries, and 11% to infections. Common types of drug-related side effects were acute kidney injury, excessive bleeding, hypotension, and delirium.
2. Adverse events. Of the 25% of Medicare patients who experienced harm, about half experienced adverse events that resulted in longer hospital stays, permanent harm, life-saving intervention, or death. The majority of adverse events, 74%, contributed to or resulted in prolonged institutional stay, increased levels of care, transfer to another facility, or subsequent hospitalization. Another 10% of adverse events resulted in patient death: an estimated 1.4% of the approximately one million Medicare hospitalized patients died during the month-long study period in 2018. Most of these patients had multiple complex comorbidities, including cancer, morbid obesity. , dementia, kidney failure and diabetes.
3. Prevention of causing harm to the patient. Reviewing physicians selected by HHS determined that 43% of all adverse events and events with temporary harm could be prevented in some way, and 56% could not be prevented. Among the preventable events, 33% were associated with patients receiving poor-quality treatment or therapeutic care, and 31% were associated with patients receiving inadequate preventive care. The experts determined that in the OIG sample group, seven of the 11 adverse events that contributed to or led to death were preventable.
4. Comparison with the 2010 report. OIG first reported the national incidence of patient harm in hospitals in 2010 based on a sample of Medicare patients in October 2008. Harm rates have remained largely unchanged since then, with 27% of patients experiencing harm in 2008 . About 44% of these events were considered preventable, as in the latest report. There were slightly more side effects and slightly fewer temporary harms in the 2008 sample than in the 2018 group.
5. Recommendations for preventing further cases of harm to the patient. Based on its latest findings, the OIG said it recommends that Medicare and Medicaid Service Centers expand the number of in-hospital conditions listed in its harm prevention incentive policy to include common, preventable, and costly harms. In addition, CMS should develop guidance for inspectors on assessing hospital compliance with requirements to track and monitor patient harm, the OIG said in a statement. The watchdog recommended that the Agency for Medical Research and Quality update its agency-specific strategic quality plans and continue its efforts to develop new strategies to prevent routine patient harm in hospitals.