Sobering News on Quality Front

Last month, the Office of Inspector General (OIG) issued a report (PDF) that estimates 15,000 Medicare patient deaths each month are attributable at least in part to the care they received in hospitals.

The federal watchdog agency tallied adverse events from the National Quality Forum’s list of serious reportable events and other hospital-acquired conditions in the charts of 780 Medicare patients from 2008, then extrapolated the proportions harmed through hospital care (13.5%) or who die as a result of that care (1.5%).

“Because many adverse events we identified were preventable, our study confirms the need and opportunity for hospitals to significantly reduce the incidence of events,” the report concludes. It recommends that the Agency for Healthcare Research and Quality (AHRQ) broadens patient-safety efforts and that the Centers for Medicaid & Medicare Services (CMS) provides further incentives for hospitals to reduce their incidences through its payment and oversight functions.

Confirmation of hospital safety concerns comes from a study published in the New England Journal of Medicine (2010;2363:2124-2134) that found harm to patients in North Carolina hospitals was common and did not decrease from 2002 to 2007.

Christopher Landrigan, MD, of Harvard Medical School and coauthors concluded that 18% of hospitalized patients were harmed through their medical care and, for 2.4%, it caused or contributed to their deaths.

The results of the OIG study are not surprising and might even underestimate the extent of the problem, says Gregory Seymann, MD, a hospitalist at the University of California at San Diego and a member of the Society of Hospital Medicine’s Performance and Standards Committee. The report doesn’t address what proportion of the harmed patients was on a service managed by hospitalists, “but we are in the best position to impact quality and safety—to go to our hospital administrators and get resources earmarked for quality,” he says.

Such results also mirror findings from the Institute of Medicine’s landmark 1999 report To Err is Human, adds Andrew Dunn, MD, a hospitalist at Mount Sinai Medical Center in New York City. “They suggest that medical errors are rampant in hospitals,” he says. “Because the incidence of harm is so broad across the elderly population, quality-improvement efforts in hospitals need to be across the board.”

Every hospitalist should be involved with these efforts, Dr. Dunn says. “There’s no putting your feet up. There’s always room to improve quality,” he adds. He predicts that safety outcomes will increasingly be tied to hospital reimbursement, “which is a good thing. It’s very motivational.”

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