A work in progress
Recent patient-safety data show there’s still a long road ahead for providers
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.