Hospital safety was on track before COVID-19, says AHRQ

In the ten years before the COVID-19 pandemic, adverse events related to hospital safety dropped by more than 30%, according to a study published Tuesday in JAMA.

According to the Agency for Medical Research and Quality, health systems safety and quality initiatives have reduced the number of side effects associated with infections, drugs or operations among patients hospitalized with acute myocardial infarction, heart failure, pneumonia and major surgery since 2010 to 2019

“We have every reason to be hopeful,” AHRQ administrator David Rodrik said in a statement. “This study shows that the efforts of frontline healthcare professionals, organizations, federal agencies, and the broader patient safety community have worked. The entire community focused on measurable goals, implemented evidence-based methods, and engaged with leaders.”

An obvious limitation of the results is that they do not reflect the challenges that COVID-19 has presented to hospitals over the past two-plus years.

“While we are pleased that this study shows that progress has been made, we will focus our efforts on further harm reduction and continue to track acquired disease rates at the National Hospital,” Rodrik said. “Preliminary figures show that some areas of harm to patients have increased in the midst of the pandemic.”

Due to a lack of hospital resources, delays in care, less interaction between patients and clinical staff, and more traveling workers, keeping patients safe has become more difficult, said Dr. Connecticut School of Medicine and studylead investigator.

Between 2010 and 2019, the rate of adverse events in heart attack patients decreased by 36%, from 218 to 139 events per 1,000 discharges. Rates decreased by 31% in patients with heart failure, by 39% in patients with pneumonia, and by 36% in patients undergoing major surgery. The researchers examined the medical records of almost 245,000 adult patients in 3,156 hospitals.

The relative risk of adverse events decreased by 41% in patients with a heart attack, by 27% in patients with heart failure, by 36% in patients with pneumonia, by 41% in patients with major surgery, and by 18% in patients with all other conditions.

The successes of the entire system over the past 10 years may have contributed to these positive results, Metersky said. Among them, he said, are better supervision and guidance of medical trainees, greater use of infection control specialists, and greater adoption of electronic health records. The Centers for Medicare and Medicaid Services have also put in place financial incentives to keep patients safe, he said.

It appears that during a pandemic, patient safety is on the opposite trend. Between the second quarter of 2019 and 2020, data from the Centers for Disease Control and Prevention shows, for example, a 28 percent increase in the standardized infection rate for central line bloodstream infections. In 2020, in intensive care settings, the standardized infection rate increased by 39%, with 1,911 adverse events occurring in the second quarter of the same year.

While CMS continues to collect quality data, it has also suspended some safety measurement and public reporting requirements due to the damage to hospitals from the pandemic. This has raised questions about transparency and the ability of healthcare systems to sustain progress in patient safety.

“The big question is what successful hospitals were doing that led to improvements before the pandemic,” said Anupam Jena, assistant professor of health policy at Harvard Medical School. It is also important to understand why other hospitals have not become safer, he said.

Jena said despite the stress COVID-19 is causing, the pandemic has provided healthcare systems with lessons to learn that could better prepare them to care for patients. Once the public health emergency passes, hospitals will be able to restore patient safety, he said.

“Whatever we learn, the core processes that have evolved over the last decade or so will not disappear because of the pandemic,” Jena said. “The infrastructure will remain.”

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