Thinking About Health: Hospital mistakes still kill too many
February 7, 2015
Few people go to the hospital expecting their hospital stay to kill them. But sometimes it does. No one is sure of the precise number of people who die because of mistakes made in hospitals, but it's not small. Every patient is potentially at risk.
Even though hospitals don't intentionally harm people in their care, they have not faced any bottom-line penalties when they do. That's now changing.
In 1999 when the Institute of Medicine (IOM) issued its landmark report, "To Err is Human," it estimated as many as 98,000 people died each year because of hospital errors.
In 2010 the Office of the Inspector General for the Department of Health and Human Services found that bad hospital care contributed to the deaths of some 180,000 Medicare patients in a given year.
And in 2013 John James, a NASA toxicologist, found that as many as 440,000 patients suffer preventable harm in hospitals every year. His report was published in the Journal of Patient Safety.
Why are so many Americans still dying from preventable mistakes 16 years after the IOM called attention to the problem?
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I explored this question and others recently with Dr. Ashish Jha, professor of health policy at the Harvard School of Public Health and one of the country's leading experts on patient safety. Jha told me no one really knows why hospitals have not reduced the harm caused by mistakes. "While we have clearly made some progress in a few areas, there has been little progress in other important areas of patient safety," he said.
Rates for surgical site infections and central line infections are down 40 to 50 percent nationally. (Central lines are catheters inserted in the chest or neck veins to administer fluids and medicines to critically ill patients.) But Jha said studies show little to no progress on reducing catheter-related urinary infections, which can be fatal. "The latest data from the Centers for Disease Control and Prevention says these rates are just not meaningfully getting better."
He added that blood clots continue to be a problem even though "'we generally know how to prevent them." Blood thinners and special boots that keep blood from stagnating can be helpful, but not all hospitals are using them.
If we know how to prevent these problems, why aren't we doing that?
"To be frank it really isn't anyone's top priority — except maybe the patient," Jha told me. Hospital CEOs generally don't get fired because of the hospital's infection rates. Salaries are tied to things like fund raising and having high-tech equipment. "There's no evidence that having a high infection rate or a high mortality rate has any effect on CEO salaries," Jha said.
But hospitals could soon see their bottom lines suffer. In December, Medicare announced it was penalizing 721 hospitals across the country that it determined have high rates of exactly the kinds of errors Jha talks about. These include central-line infections, catheter- associated urinary infections and serious complications based on injuries including blood clots, bed sores and falls.
Hospitals penalized for these complications lose one percent of each Medicare payment made to them over the year. This means the loss of tens of thousands or even hundreds of thousands of dollars.
I looked at Medicare data for hospitals in the four states participating in the Rural Health News Service and yep, there were penalties assessed — some against well-known hospitals such as Indiana University Health Methodist Hospital, Centura-Health St. Anthony Hospital in Colorado, Sanford USD Medical Center in South Dakota and Alegent Creighton Health-Creighton University Medical Center in Nebraska.
One-third of all eligible hospitals in Colorado and almost one-third of those in Nebraska were penalized. In Indiana and South Dakota, fewer than 20 percent were. Some hospitals like small critical access hospitals and children's hospitals are exempt.
So you see even the big well-known hospitals can pose safety risks to patients. Since most errors are caused by systemic failures, what can patients on their own do? You can examine data for hospitals in your state using the government's Hospital Compare site http://www.medicare.gov/hospitalcompare/search.html, and check the http://patientsafetyamerica.com/ website of Patient Safety America. You
should speak up if you think something isn't right.
"We are now at the point where I am asking patients who are sick and often in pain to be their own advocates for safety because the system hasn't done its job," said Jha. "We don't expect airline passengers to advocate for safety when they get on an airplane."
Have you or a family member experienced a medical error? We want to hear from you. Write to Trudy at email@example.com.
Editor’s note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.