Monday, April 11, 2011

Healthcare Can Be Dangerous

Cheryl Clark on HealthLeaders Media provides us with some eye-popping data in an article informatively titled 1 in 3 Hospitalized Patients Suffers an Adverse Event. She discusses several articles from the April, 2011 issue of Health Affairs which focuses on quality in healthcare.

The article that generated the title described a study of available reporting methods for detecting and tallying serious adverse events in hospitals.
“In one report, researchers who studied three methods to detect serious adverse events conclude that the commonly used method of voluntary reporting and the Agency for Healthcare Research and Quality's Patient Safety Indicators capture only one-tenth of these flaws in care.”

“On the other hand, a newer tool developed by the Institute for Healthcare Improvement, called the Global Trigger Tool, now used by only 2% of hospitals in the U.S., caught all 10.”

“Specifically, the GTT detected 354 adverse events, while the AHRQ system, used by roughly half the hospitals in the U.S., found only 35 and the voluntary method found just four, according to the authors. These adverse events include medication errors, procedural errors and hospital-acquired infections, pulmonary venous thromboembolisms, pressure ulcers, device failures and patient falls.”

"’Overall, adverse events occurred in 33.2% of hospital admissions (range: 29% to 36%) or 91 events per 1,000 patient days,’ says the lead author, David Classen, MD, associate professor of medicine at the University of Utah in Salt Lake City.”
In other words, based on this data, you have a 33% chance, every time you are admitted to a hospital, of being harmed in a manner that is not related to your illness. Clark points out that it could be even worse than this.
“What's even more worrisome is that Classen says the hospitals selected for this study are already ahead of the curve. They already had extensive patient safety programs and are much further along in their patient safety and adverse event detection journey than other hospitals.”
“So there are 10 times more harmful medical errors than we knew about, even at the best hospitals.”
Clark asks the pertinent question: “how can you have an Accountable Care Organization when you don’t know how to account for care?”

Even more bad news is provided. There is another article in Health Affairs that discusses the social cost of adverse medical events. From the abstract:
“Adverse medical events—medical interventions that cause harm or injury to a patient separate from the underlying medical condition—are unfortunately an all-too-frequent occurrence in US hospitals. They may cause as many as 187,000 deaths in hospitals each year, and 6.1 million injuries, both in and out of hospitals. We estimate the annual social cost of these adverse medical events based on what people are willing to pay to avoid such risks in non–health care settings. That social cost ranges from $393 billion to $958 billion, amounts equivalent to 18 percent and 45 percent of total US health care spending in 2006. A possible solution: Patients offered voluntary, no-fault insurance prior to treatment or surgery would be compensated if they suffered an adverse event—regardless of the cause of their misfortune—and providers would have economic incentives to reduce the number of such events.”
So—healthcare providers lure you into these casinos called hospitals and charge a fortune to fix what is already wrong, and then they damage something in the process and charge another fortune to fix that. Such a deal!

Actually, the more horror stories one hears about waste in healthcare, the more optimistic one becomes that costs will be controlled. All we have to do is convince people to stop doing stupid things—and then convince them to stop doing illegal things. How hard can that be?

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