Harmed pa­tients ‘keep me from be­ing pulled into the providers’ ex­cuses’

Modern Healthcare - - Q & A -

Lisa McGif­fert is the di­rec­tor of the Con­sumers Union’s Safe Pa­tient Pro­ject, which en­gages in ad­vo­cacy and ed­u­ca­tion on pa­tient-safety is­sues.

She serves as the con­sumer li­ai­son to the Cen­ters for Dis­ease Con­trol and Preven­tion’s healthcare in­fec­tion con­trol prac­tices ad­vi­sory com­mit­tee and as con­sumer rep­re­sen­ta­tive on the Na­tional Qual­ity Fo­rum’s in­fec­tion con­trol steer­ing com­mit­tee. McGif­fert was in­cluded on Mod­ern Healthcare’s list of 100 Most In­flu­en­tial Peo­ple in Healthcare for 2015. Mod­ern Healthcare re­porter Sabriya Rice re­cently spoke with McGif­fert about hos­pi­tal ef­forts to re­duce in­fec­tions, the preva­lence of other types of med­i­cal er­rors, and con­gres­sional leg­is­la­tion to speed drug and de­vice ap­provals. This is an edited tran­script.

Mod­ern Healthcare: How did the Safe Pa­tient Pro­ject get started?

Lisa McGif­fert:

In 2003, I pro­posed that we do a na­tional cam­paign to get hos­pi­tals to pub­licly re­port in­fec­tion rates, and that we pro­pose leg­is­la­tion in all the states. We were suc­cess­ful in get­ting leg­is­la­tion passed in more than 30 states. Right around that time, the fed­eral gov­ern­ment ini­ti­ated its pro­gram to re­quire all hos­pi­tals to re­port through­out the coun­try.

MH: How are hos­pi­tals do­ing on re­duc­ing healthcare-ac­quired in­fec­tions?

McGif­fert: Ev­ery­body who goes into the hos­pi­tal should be aware there is a risk of in­fec­tion. Pa­tients are ill when they go to the hos­pi­tal, so we can­not put it on them to be the first line of de­fense. It’s a real dif­fer­ent world to­day than it was in 2003, when I started. The most com­mon re­sponse I got when we talked about try­ing to stop hos­pi­tal in­fec­tions was that they could not be pre­vented. Now there is over­whelm­ing sup­port for preven­tion. A lot of that change is at­ti­tude, but some of it is tech­nol­ogy, knowl­edge, test­ing and scal­ing up suc­cess­ful preven­tion pro­grams. We’ve seen a sig­nif­i­cant re­duc­tion of cen­tral line-as­so­ci­ated blood­stream in­fec­tions in the ICU, which al­most ev­ery state re­quired hos­pi­tals to re­port and for which the fed­eral gov­ern­ment re­quired re­port­ing. You need to have re­port­ing, but you also need to have preven­tion ini­tia­tives. We saw large preven­tion ini­tia­tives on re­duc­tion of cen­tral line-as­so­ci­ated blood stream in­fec­tions, so there was a lot of train­ing go­ing on. The third com­po­nent was hos­pi­tals know­ing Medi­care would pay them less if their CLABSI rates were higher.

MH: Are providers still re­sis­tant to trans­parency?

McGif­fert:

They’re em­brac­ing some of the things we’re do­ing now. But we’re just touch­ing the tip of the ice­berg on healthcare-ac­quired in­fec­tions. Hope­fully, we will even­tu­ally get to a place where we’re doc­u­ment­ing pretty much all that is hap­pen­ing. But right now, we’re not any­where near that. For ex­am­ple, we don’t get enough in­for­ma­tion about sur­gi­cal-site in­fec­tions. There is no rea­son why Medi­care shouldn’t re­port sur­gi­cal­site in­fec­tion rates on hip and knee im­plants.

Hos­pi­tals push back on doc­u­men­ta­tion. They say it’s too la­bor-in­ten­sive. But I re­mem­ber the early days when they said, “It’s just im­pos­si­ble to keep track of how many days a cen­tral line is in a pa­tient.” It wasn’t im­pos­si­ble.

MH: How is the healthcare in­dus­try do­ing on pa­tient­cen­tered care?

McGif­fert: We still hear out­ra­geous sto­ries about how pa­tients are treated. While more hos­pi­tals are try­ing to change the way they do things, too many pa­tients are not treated with dig­nity and re­spect. And pa­tients who feel that they weren’t treated with dig­nity and re­spect had a higher rate of med­i­cal er­rors.

MH: What types of med­i­cal er­rors need more at­ten­tion?

McGif­fert: We have a lot of work to do track­ing and pre­vent­ing er­rors other than in­fec­tions. We re­ally don’t have much in­for­ma­tion about er­rors other than that mil­lions and mil­lions are hap­pen­ing ev­ery year. There are a lot of is­sues around di­ag­nos­tic

“You need to have re­port­ing, but you also need to have preven­tion ini­tia­tives.”

er­rors. That’s the first step where you en­ter or don’t en­ter the healthcare sys­tem, so that’s very im­por­tant.

Most of the work on er­rors is fo­cused on those that cause se­ri­ous in­jury or death, but there are mil­lions of peo­ple who have had their lives changed be­cause of a med­i­cal er­ror that didn’t cause per­ma­nent dam­age but in­ter­rupted their lives for a year or two. Peo­ple don’t re­ally think about the im­pact of huge med­i­cal bills and not be­ing able to work be­cause of a med­i­cal er­ror.

On cer­tain er­rors, Medi­care does not pay the hos­pi­tal the cost of tak­ing care of the pa­tient af­ter the er­ror oc­curs. The hos­pi­tal is held re­spon­si­ble only for that hos­pi­tal­iza­tion. Medi­care will pay for the years of re­ha­bil­i­ta­tion or wound treat­ment. I think hos­pi­tals should be re­spon­si­ble for that. Usu­ally, the pa­tient bears the brunt, and of­ten it changes their lives sig­nif­i­cantly even if they even­tu­ally get bet­ter.

MH: What do you think of hos­pi­tal ini­tia­tives to reach out to pa­tients once a mis­take has been iden­ti­fied?

McGif­fert: Apol­ogy pro­grams are very good as long as they don’t take away the rights of the pa­tient to hold the hos­pi­tal li­able, be­cause a pa­tient may have sig­nif­i­cant costs due to that er­ror. Most pa­tients who are harmed want to know what hap­pened. Most aren’t look­ing for money, they are look­ing for in­for­ma­tion. It’s a risky sit­u­a­tion for hos­pi­tals when they open up and apol­o­gize. But many hos­pi­tals are tak­ing that risk and they’re show­ing re­ally good re­sults.

MH: What are your con­cerns about the 21st Cen­tury Cures Act in Congress?

McGif­fert: It would lessen the rigor in ap­prov­ing an­tibi­otics, so drugs that prob­a­bly have more po­ten­tial to harm than what we see now are go­ing to be on the mar­ket. This is a huge prob­lem be­cause it’s based on a the­ory that the drug or de­vice can go through to the mar­ket quickly and then there will be some kind of mag­i­cal post-mar­ket sur­veil­lance sys­tem that will track any prob­lems. Then, as soon as there’s a prob­lem they’ll take it off the mar­ket. I’ve heard the spon­sors of this bill say that. Well, it doesn’t hap­pen that way. It usu­ally takes years and years of col­lect­ing ev­i­dence be­fore the FDA even is­sues warn­ings about de­vices or drugs that may have prob­lems. In the mean­time, mil­lions of peo­ple have been ex­posed to them.

We need to be sure we have a process that en­sures safety of drugs and de­vices. We don’t want it to be oner­ous, but it needs to en­sure safety. And we re­ally need to build up our post­mar­ket sur­veil­lance.

MH: What keeps you mo­ti­vated in work­ing to im­prove pa­tient safety?

McGif­fert: We work with a lot of pa­tients who have been harmed and who speak out and want to change the sys­tem in a con­struc­tive way. That more than any­thing inspires me. They keep me from be­ing pulled into the providers’ ex­cuses. We can say that things are im­prov­ing, but they are not im­prov­ing enough if 75,000 Amer­i­cans are dy­ing from healthcare-ac­quired in­fec­tions ev­ery year.

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