Thursday, April 19, 2007

Patient Safety in Hospitals

Under my "Credible Evidence" links on the right I have added a new link to the full Fourth Annual Patient Safety in American Hospitals Study by HealthGrades. Please look over the report as well as their web site http://www.healthgrades.com/. I have taken the liberty to quote part of the summary of the study findings here. It's well worth looking at though not exactly a pat on the back to our health care system. Goodness, is something broke? If you examine some of the other links under Credible Evidence you will see that more than this study seem to point that direction.

"Summary of Findings
AHRQ’s development of the Patient Safety Indicators (PSIs) was based on the Institute of Medicine’s (IOM) definition of patient safety— “freedom from accidental injury due to medical care, or medical errors.” Medical error is defined as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim…[including] problems in practice, products, procedures, and systems.”

In 2002, AHRQ, in collaboration with the University of California-Stanford Evidence-Based Practice Center, identified 20 indicators of potentially preventable patient safety incidents that could be readily identified in hospital discharge data. This tool set of 20 evidence-based PSIs was created and released to the public in 2003 to be used by various healthcare stakeholders to assess and improve patient safety in U.S. hospitals.
In our study, we found:
• Approximately 1.16 million total patient safety incidents occurred in over 40 million hospitalizations in the Medicare population, which is almost a three-percent incident rate. These incidents were associated with $8.6 billion of excess cost during 2003 through 2005.
• More than half (10 of 16) of the patient safety incident rates studied worsened from 2003 to 2005. These ten indicators worsened, on average, by over 11.5 percent while the other six indicators improved, on average, by eight percent.
• The total patient safety incident rate worsened by an additional 2.0 incidents per 1,000 hospitalizations in 2005 compared to 2003.
• The PSIs with the highest incidence rates were decubitus ulcer, failure to rescue, and post-operative respiratory failure. Failure to rescue improved six percent during the study period, while both decubitus ulcer and post-operative respiratory failure worsened by almost 10 and 20 percent, respectively.
• Of the 284,798 deaths that occurred among patients who developed one or more patient safety incidents, 247,662 were potentially preventable.
• Medicare beneficiaries that developed one or more patient safety incidents had a one-in-four chance of dying during the hospitalization during 2003 to 2005.
• There were wide, highly significant gaps in individual PSI and overall performance between the Distinguished Hospitals for Patient Safety™ and the bottom ranked hospitals.
• Medicare patients in the Distinguished Hospitals for Patient Safety™ had, on average, approximately a 40-percent lower occurrence of experiencing one or more PSIs compared to patients at the bottom ranked hospitals. This finding was consistent across all 13 PSIs studied.
• If all hospitals performed at the level of Distinguished Hospitals for Patient Safety™, approximately 206,286 patient safety incidents and 34,393 Medicare deaths could have been avoided while saving the U.S. approximately $1.74 billion during 2003 to 2005.

See also this and this.
"Choosing a hospital for even for a simple, routine procedure can be a life or death decision, and the key element that determines a patient’s outcome for any given procedure or diagnosis is a hospital’s adherence to quality measures."

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