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U.S. hospitals became much safer places for patients over the past decade, with medical errors and adverse events declining significantly across the nation, federal government data show.
Between 2010 and 2019, patient safety dramatically improved among the four types of conditions for which people are most often hospitalized: heart attacks, heart failure, pneumonia and major surgical procedures.
People hospitalized for those problems became less likely to suffer from medication errors, hospital-acquired infections, procedure-related adverse events, pressure ulcers from being bedridden, or serious falls that cause injury, researchers found.
“There has been a precipitous, very important drop in the number of these events, which to me validates the idea that these were preventable,” said senior researcher Dr. Harlan Krumholz, director of the Yale New Haven Hospital Center for Outcomes Research and Education in New Haven, Conn. “The status quo wasn't written in stone. We have been able to actually make hospitals safer for those conditions.”
The new study relied on data gathered by the Medicare Patient Safety Monitoring Program, an effort created in the wake of a landmark 1999 Institute of Medicine report that drew national attention to patient safety in hospitals, the study authors said in background notes.
“There was a recognition that patients are being harmed in hospitals, and we can't determine if things are getting better without tracking them in a reliable, consistent way,” said co-researcher Dr. Mark Metersky, a professor of medicine at the University of Connecticut School of Medicine, in Farmington.
The researchers analyzed the de-identified medical records of nearly 245,000 patients treated at more than 3,100 U.S. hospitals during the past decade, looking at a list of 21 potential harms that can befall a hospitalized person during their stay.
The investigators found that for the four most common reasons a person winds up in the hospital, safety has indeed improved:
- Heart attacks (17% of hospitalizations) had a reduction in adverse events from 218 to 139 per 1,000 discharges.
- Heart failure (17%) had an adverse event reduction from 168 to 116 per 1,000 discharges.
- Pneumonia (21%) had adverse events fall from 195 to 119 per 1,000 discharges.
- Major surgical procedures (22%) experienced a decline from 204 to 130 adverse events per 1,000 discharges.
Adverse drug events, hospital-acquired infections, and general adverse events declined significantly across all patient groups, the findings showed. Events following a major surgery also declined.
“In the last 10 years, the rates of those events overall have declined, so hospitals are becoming safer, at least as measured by this metric,” Metersky said.
He said some of this probably is due to advances in medicine. For example, patients undergoing keyhole surgery are at much lower risk of complications than patients who require a large incision.
But a large part of it is also due to improvement programs undertaken by hospitals to reduce harmful events like medication errors and infections, Metersky and Krumholz said.
“The results in the study certainly are positive news for hospitals and we think really reflects the relentless focus on improving the quality and safety of care that hospitals have had for many years,” said Akin Demehin, the American Hospital Association's senior director of quality and patient safety.
“During the period covered by the study, we saw an acceleration of any number of efforts to rigorously assess care inside hospitals, identify ways of making it better, identifying ways in which it may be falling short, and then using multiple different kinds of process improvement methodologies to not only carefully measure the problem but implement solutions to make care better and safer,” Demehin added.
Interestingly, patient safety did not improve within a fifth catch-all category for all health conditions that fall outside the major four, the researchers noted.
“We don't know why that is,” Metersky said. “Part of that may be because they're not as high risk, so they have fewer events already, and it may be harder to improve. Another part may be that the four conditions for which we did see improvement have been more targeted for quality improvement efforts.”
Metersky, Krumholz and Demehin all agreed on one important point – there's still more room for improvements in patient safety.
“Medicine still needs to ... embrace the idea that we really don't want anyone harmed in the course of receiving care,” Krumholz said. “These people are vulnerable, they're sick, and they're coming to us for help. They deserve to not have anything occur in the course of their care.”
It's good that hospitals are getting safer, he said.
"But we're really not even halfway through the journey that we need to be on, which is to get to a destination where really everyone going to the hospital can feel confident that it's a safe place and that they're going to get their condition treated and they're not going to come up with something else because of an error or lapse in safety or any other issue,” Krumholz said.
The findings were recently published in the Journal of the American Medical Association.
The World Health Organization has more about patient safety.
SOURCES: Harlan Krumholz, MD, director, Yale New Haven Hospital Center for Outcomes Research and Education, New Haven, Conn.; Mark Metersky, MD, professor, medicine, University of Connecticut School of Medicine, Farmington, Conn.; Akin Demehin, MPH, senior director, quality and patient safety, American Hospital Association, Washington, D.C.; Journal of the American Medical Association, July 12, 2022
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