Hospitals in the United States reduced their medical errors by 17 percent between 2010 and 2013 — an effort that saved about 50,000 lives, as well as $12 billion dollars, according to a report released this week by the Department of Health and Human Services (HHS).
The reasons for this progress are not fully understood, but HHS officials point out that likely contributing causes include Medicare incentives under the 2010 Affordable Care Act (ACA), which financially penalize hospitals for poor-quality care and too-quick patient readmissions, as well as other government initiatives, such as Partnership for Patients, a public-private program that targets 10 specific areas of patient safety.
“Today’s results are welcome news for patients and their families,” HHS Secretary Sylvia M. Burwell said in a statement released with the report. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely. HHS will work with partners across the country to continue to build on this progress.”
Profiting from mistakes
Calling the results “welcome news” is truly an understatement. For “hospital-acquired conditions” — things like infections, pressure ulcers (bedsores), injuries from falls, and complications resulting from mistakes in administering medicines — are a major public health problem.
In 2010, the HHS reported that as many as 180,000 people die in the United States each year as a result of poor hospital care. Among hospitalized Medicare patients, almost a third (27 percent) develop some kind of injury related to their care, the HHS officials also pointed out. Half of those Medicare injuries result in a prolonged hospital stay, permanent harm, a life-sustaining medical intervention — or death.
Until very recently, not only did hospitals lack the financial incentive to reduce their medical errors, they actually profited from such mistakes because of all the extra care that such errors generate. A 2013 study found, for example, that hospitals received $39,500 more, on average, when a privately insured patient experienced a surgical complication than when the surgery was complication-free. The benefit to the hospital when a Medicare patient had a surgical complication was an average of $1,800 — much less, but still a significant amount, given the large number of Medicare patients who are hospitalized each year.
Improvements accelerated in 2013
For the new report, HHS researchers analyzed data in up to 33,000 medical records of hospitalized patients for each year between 2010 and 2013. (Medical records before then could not be used in this study because pre-2010 data was collected in a different, non-comparable way.)
The analysis revealed 1.3 million fewer incidents of hospital-related errors in 2011-2013 compared to 2010. The largest portion of that improvement occurred in 2013. That year, hospitals committed an estimated 800,000 fewer errors than in 2010, a drop of 17 percent. In addition, 35,000 of the 50,000 deaths averted between 2011-2013 due to reductions in hospital errors occurred in 2013 alone.
The errors with the biggest decline — about 40 percent — were adverse drug events. (Such mistakes include giving a patient the wrong drug or the wrong dose of a drug). Other major areas of improvement were bedsores (20 percent of the overall reduction in errors) and catheter-associated urinary tract infections (14 percent).
The reduction in bedsores had the largest impact, saving the most lives (an estimated 20,000) and $4.8 billion in healthcare costs.
What patients can do
These improvements are impressive, but hospital errors remain a serious public health problem. As the HHS researchers acknowledge in their report, 10 percent of U.S. hospital patients will experience one or more harmful medical errors this year.
“Despite the tremendous progress to date in reducing [hospital-acquired conditions], much work remains to be done to ensure that the U.S. health care system is a safe as it can possibly be,” they write.
In the meantime, patients and their families can take steps to help minimize the risk of developing a hospital-acquired medical condition. In an article it published last year on hospital safety, the AARP offered the following suggestions:
1. Check credentials. Make sure the hospital is accredited by The Joint Commission, the chief hospital accrediting organization in the U.S. (qualitycheck.org).
2. Ask questions. “Overwhelming data show that when patients actively participate in their own care, they have better outcomes,” says Peter J. Pronovost, M.D., patient-safety expert at Johns Hopkins.
3. Bring an advocate. Another set of eyes and ears monitoring your care helps. “I slept in a cot by my mother’s side for two days when she was in the hospital,” says Robert M. Wachter, M.D., associate chair of the department of medicine at the University of California, San Francisco.
4. Be persistent. Make sure providers follow standard procedures for common practices like inserting IV lines.
You can read the HHS report on the agency’s website.