Much broader safety efforts and financial incentives are needed to reduce adverse events in hospitals, according to a new study.
An estimated 13.5% of Medicare beneficiaries experience an adverse event during hospital stays, resulting in costs of around $4.4 billion, according to new research from the Office of Inspector General (OIG).
The report, entitled “Adverse Events in Hospitals: National Incidence among Medicare Beneficiaries,” found that of the nearly 1 million Medicare beneficiaries discharged from hospitals in October 2008, about one in seven experienced an adverse event, and an estimated 1.5% experienced an event that contributed to their deaths, which projects to 15,000 patients in a single month.
An additional 13.5% of Medicare beneficiaries experienced events during their hospital stays that resulted in temporary harm, defined as events “that require intervention but do not cause lasting harm. Although many cases represent fairly minor occurrences, such as hypoglycemia, others were classified as temporary harm only because the patients were in the hospital for lengthy periods as a result of other, more serious, diagnoses, allowing hospitals enough time to address the harm prior to discharge,” according to the report.
Additionally, 28% of beneficiaries who experienced adverse events also had temporary harm events during the same stay.
Perhaps the most telling statistic, however, was the fact that 44% of adverse and temporary harm events were clearly or likely preventable, according to physician reviewers. They found that events related to surgery or procedures were less likely to be preventable than other types of events, such as hospital-acquired infections, and that preventable events were linked most commonly to medical errors, substandard care, and lack of patient monitoring and assessment.
In terms of the price tag, the report found that hospital care associated with adverse and temporary harm events cost Medicare an estimated $324 million in October 2008; 16% of beneficiaries in the Medicare Inpatient Prospective Payment System who experienced events incurred additional Medicare costs as a result. These added costs equate to an estimated 3.5% of Medicare’s expenditure for inpatient care during October 2008.
To give these figures an annual context, said the report, 3.5% of the $137 billion Medicare inpatient expenditure for fiscal year 2009 equates to $4.4 billion spent on care associated with events. Two-thirds of Medicare costs associated with events were the result of entire additional hospital stays necessitated by harm from the events—and these estimates don’t include additional costs required for follow-up care after the sample hospitalizations.
“Because many adverse events we identified were preventable,” this study confirms the “need and opportunity for hospitals to significantly reduce the incidence of events.” The OIG recommends that the CMS and the Agency for Healthcare Research and Quality broaden their definition of adverse events and identify them more clearly. Additionally, CMS should expand the list of adverse events that will not be covered, and should seek opportunities to hold hospitals accountable for adopting evidence-based practice guidelines, according to the report.
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