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

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.