The annual Patient Safety in American Hospitals Study by Health Grades Inc., finds that errors in treatment resulted in 238,337 potentially preventable deaths of Medicare patients in the US, costing $8.8 billion.
In their summary of findings they describe a Medical Error 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."
Approximately 1.12 million total patient safety incidents occurred in almost 41 million hospitalizations in the Medicare population, an almost three-percent incident rate. This rate is relatively unchanged from previous studies. These incidents were associated with almost $8.8 billion of excess cost during 2004 through 2006.
63.41 percent of patient safety incidents came from decubitus ulcer, failure to rescue, and post-operative respiratory failure.
Failure to rescue improved 11.11 percent during the study period, while both decubitus ulcer and post-operative respiratory failure worsened during the study period.
On page 21 of the report they describe 16 different patient safety incident rates and associated mortality among Medicare beneficiaries, which are, Complications of anesthesia, Death in low mortality DRGs, Decubitus ulcer, Failure to rescue, Foreign body left in during procedure, Iatrogenic pneumothorax, Selected infections due to medical care, Post-operative hip fracture, Post-operative hemorrhage or hematoma, Post-operative physiologic and metabolic derangements, Post-operative respiratory failure, Post-operative pulmonary embolism or deep vein thrombosis, Post-operative sepsis, Post-operative wound
dehiscence in abdominopelvic surgical patients, Accidental puncture or laceration, and Transfusion reaction.
There were 270,491 actual in hospital deaths that occurred among patients who developed one or more of the 16 patient safety incidents and the report states (page 4), "Using previous research, we calculated that 238,337 were attributable to patient safety incidents and potentially preventable."
If all hospitals performed at the level of Distinguished Hospitals for Patient Safety, approximately 220,106 patient safety incidents and 37,214 Medicare deaths could have been avoided while saving the U.S. approximately $2.0 billion during 2004 to 2006.
In a prepared statement, HealthGrades' chief medical officer and primary author of the study, Dr. Samantha Collier, said, "While many U.S. hospitals have taken extensive action to prevent medical errors, the prevalence of likely preventable patient safety incidents is taking a costly toll on our health care systems -- in both lives and dollars", she continues, "HealthGrades has documented in numerous studies the significant and largely unchanging gap between top-performing and poor-performing hospitals. It is imperative that hospitals recognize the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost."
According the Washington Post article (linked above), as of October 1, 2008, federal Centers for Medicare and Medicaid Services, will no longer reimburse hospitals for treatment of eight major preventable errors, which include, objects left in the body after surgery and certain kinds of post-surgical infections.
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