The rate at which patients got sick, were injured or died because of errors in U.S. hospitals plateaued last year, suggesting that remaining safety issues will be hard to tackle, a government report released Tuesday shows.
According to the Agency for Healthcare Research and Quality, which wrote the report, hospitals caused 4 million infections or other injuries in 2014 – 9,800 fewer than in 2013. Still, these results mean that for every 1,000 cases in which patients were released from the hospital, about 121 incidents of harm occur, whether due to bad reactions to drugs, infections at the site of surgery, falls, bedsores, or infections from tubes inserted in patients’ veins to draw blood or give fluids or medication.
Some programs to mitigate hospital harm were implemented in 2010 under the Affordable Care Act, President Obama’s health care law, which aims to make health care in the U.S. more efficient and less expensive. For instance, Medicare, the government’s health plan for adults over age 64, now penalizes hospitals when they do not demonstrate that the care they provided contributed to making a patient healthier.
Officials, in a call with reporters Tuesday, attributed reductions in harm in part to the government-launched Partnership for Patients, a public-private initiative paid for by the Department of Health and Human Services that targets specific conditions, and to the expansion of electronic medical record keeping systems.
Though the rate of complications last year was 17 percent lower than in 2010 – saving an estimated 87,000 lives and nearly $20 billion – the 2014 figure provided the same result as 2013, suggesting some approaches are working but that further reducing mistakes may be difficult for hospitals.
Dr. Richard Kronick, director of the Agency for Healthcare Research and Quality, said during a call Tuesday that issues already solved were those that were the easiest, and that the focus would shift toward those that were more complex.
Part of the answer to why dramatic changes were seen in earlier years, and less in this year’s report, he said, is that they may have been “relatively lower hanging fruit.”
“Hospitals are now working on more difficult problems,” he said.
For instance, the report shows the rate of patients suffering from bedsores are lower than they used to be, but falls have increased. Part of the reason for this, Kronic said, is that hospital staff members are encouraging patients to move more so they don’t develop bedsores. An unintended consequence, he said, is that more patients fall as a result.
One of the greatest improvements was in reducing the number of infections caused by tubes inserted into patients. Once considered an unfortunate but often unavoidable consequence of hospitalization, those infections have been reduced by 72 percent since 2010.
Dr. Patrick Conway, principal deputy administrator and chief medical officer at the Centers for Medicare and Medicaid Services, said his agency will continue to look at how to reduce the incidence of antibiotic-resistant bacteria, while balancing it to the treatment of sepsis, an illness commonly known as “blood poisoning,” that can be an unintended consequence of withholding antibiotics from patients.
Data for the report come from medical records collected each year by the Centers for Medicare and Medicaid Services, from surgical site infection data collected by the Centers for Disease Control and Prevention’s National Healthcare Safety Network, and obstetric adverse events from the Patient Safety Indicators collected by the Agency for Healthcare Research and Quality.