A work in progress

Re­cent pa­tient-safety data show there’s still a long road ahead for providers

Modern Healthcare - - Opinions Editorials -

The words “pa­tient pro­tec­tion” con­sti­tute the first part of the of­fi­cial ti­tle for the newly minted health­care re­form law—the Pa­tient Pro­tec­tion and Af­ford­able Care Act of 2010. The term would seem to be a no-brainer for an in­dus­try that claims to be safety-cen­tric and aims to “first do no harm.” But we all know the ob­jec­tive of uni­ver­sal pa­tient safety re­mains a work in progress.

For an in­dus­try that’s awash in stud­ies and data, signs of progress or re­gres­sion in health­care qual­ity are al­ways as close as the lat­est re­port be­ing re­leased. Sev­eral stud­ies in the past few weeks de­liv­ered some fresh num­bers.

New find­ings from the qual­ity-rat­ing firm HealthGrades of­fer both good news and bad on the pa­tient-safety front for hos­pi­tals. Ac­cord­ing to the an­nual anal­y­sis, this time cov­er­ing the pe­riod from 2006 through 2008, pa­tient-safety in­ci­dents are still alarm­ingly com­mon, with nearly 960,000 such in­ci­dents in­volv­ing Medi­care pa­tients at Amer­i­can hos­pi­tals over that three-year pe­riod, re­sult­ing in more than 99,000 deaths at­trib­ut­able to the events. The ac­com­pa­ny­ing cost of all this er­rant care was pegged at $8.9 bil­lion.

Mean­while, based on spe­cific pa­tient-safety in­di­ca­tors, there was im­prove­ment in some ar­eas and wors­en­ing per­for­mance in oth­ers. Un­for­tu­nately, while six in­di­ca­tors showed im­prove­ments, they ac­counted for only about 20% of the pa­tient-safety in­ci­dents.

Eight in­di­ca­tors that showed de­clines were for more-com­mon and more-se­ri­ous pa­tient-safety events—in­clud­ing bed­sores, po­ten­tially fa­tal blood clots in the lungs and post­op­er­a­tive sep­sis—and they ac­counted for the other 80% of the prob­lem­atic events. In other words, most of the gains came in the wrong cat­e­gories.

An­other piece of the re­port high­lighted the wide dis­par­i­ties in qual­ity from hospi­tal to hospi­tal and from state to state. Many hos­pi­tals posted im­pres­sive gains in their pa­tient-safety ef­forts, but not nearly enough. So along with the con­tin­u­ing chal­lenges in over­all pa­tient safety, the in­dus­try also must wres­tle with the is­sues of vari­a­tion and in­con­sis­tency.

The sem­i­nal To Err is Hu­man re­port is­sued by the In­sti­tute of Medicine back in 1999 es­ti­mated the num­ber of pa­tient deaths at­trib­ut­able to med­i­cal er­rors at about 98,000 an­nu­ally. To look at the HealthGrades find­ings would hint at ma­jor progress in keep­ing pa­tients safer, but that would be com­par­ing ap­ples to or­anges. While health­care providers can cer­tainly point to progress at their in­sti­tu­tions, the re­port puts the num­bers in per­spec­tive: “The 99,180 deaths and nearly $8.9 bil­lion likely rep­re­sent a frac­tion of the num­ber of avoid­able pa­tientsafety deaths and as­so­ci­ated costs.”

This month also brought the release of an­other data set that of­fered a var­ie­gated pic­ture of health­care providers: the per­cent­age of health­care work­ers vac­ci­nated against the flu, es­pe­cially no­table as the flu sea­son winds down.

Since 1986, ad­vi­sory com­mit­tees for the Cen­ters for Dis­ease Con­trol and Preven­tion have been rec­om­mend­ing that all health­care work­ers re­ceive an­nual vac­ci­na­tions to fight the sea­sonal flu. And since 1989, the per­cent­age re­ceiv­ing a vac­ci­na­tion never ex­ceeded 49% of the health­care work­force. That’s un­til this year, when the over­all per­cent­age hit 64.3%, thanks to the H1N1 pan­demic. Here too the num­bers aren’t all pos­i­tive. The long-term-care sec­tor put up sig­nif­i­cantly smaller per­cent­ages for both H1N1 and sea­sonal vac­ci­na­tion rates (20% and 54%, re­spec­tively) es­pe­cially com­pared with their hospi­tal-em­ployed peers (51% and 72%).

Those are es­pe­cially trou­bling num­bers given the of­ten-frag­ile pop­u­la­tion that skilled-nurs­ing fa­cil­i­ties serve, putting those pa­tients at higher risk for the po­ten­tially deadly flu. Next flu sea­son, long-term-care work­ers need to step up and dras­ti­cally im­prove those rates. It might re­quire a lit­tle ex­tra in­cen­tive. Or a shove, if that’s what it takes.

DAVID MAY As­sis­tant Manag­ing Ed­i­tor/Fea­tures

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