When a patient has a severe illness or injury, hospital care aids in their recovery, but the reverse is the case sometimes. Hospitalized patients are supposed to leave the hospital feeling better and healthier, but sometimes patients suffer more harm due to negligence from medical professionals.
“Most patient harm results in severe complications, some of which are treatable, others, which may result in death,” says Russell Berkowitz. According to the Health and Human Services Office of Inspector General (HHS-OIG) recent report, patient harm occurs in 25 percent of hospitalized Medicare patients. According to the studies, 43 percent of those events were preventable.
The Financial Effect of Patient Harm On Medicare
When Medicare patients experience harm during hospitalization, it places financial burdens on the federal healthcare program, Medicare. A recent HHS-OIG report found that Medicare patients suffer hospital harm at a relatively high rate. According to the report, the hospital harm costs Medicare hundreds of millions of dollars each month.
In October 2008, 27 percent of Medicare patients in hospitals experienced harm, according to the first report on this topic published by OIG in 2010. In terms of reimbursement, coinsurance, and deductible payments, these patient harm events cost Medicare and patients an estimated $324 million. Almost half of these harm incidents were avoidable.
Statistics From the HHS-OIG Report
The report covers adverse and temporary harm events in their patient harm assessment. According to the report, adverse events resulted in extended hospital stays, permanent harm, the need for life-saving intervention, or even death. The report defines temporary harm events as those that required intervention but did not necessitate extended hospital stays, cause permanent harm, or demand life-saving measures.
The percentage of adverse and temporary harm events among the 25 percent of Medicare patients that experienced harm was equally shared. However, Medication-related harm was the most common harm, accounting for 43 percent of all the harm events. Patients with delirium or other mental status changes, hypotension, acute kidney injury, excessive bleeding, and hypoglycemia were among those who experienced these Harm Events.
Following the medicated-related harm is harm resulting from patient care, which accounts for 23 percent of the reported events. Procedure and surgical-related patient harm account for 22 percent, while infections account for 11 percent of the reported events.
Further Significant Findings From the HHS-OIG Report
Additional key findings in the report relate to Centers for Medicare and Medicaid Services (CMS) policies. The CMS policies aim to stop Hospital-Acquired Conditions, also called HACs.
However, the report claims that the CMS policies utilize specified criteria for counting harm events and use lists of HACs with a limited scope. As a result, the ability of the CMS policies to widely promote patient safety is limited. According to the HHS-OIG findings, only five percent of all the harm events were on the CMS HAC Reduction Program (HACRP) list.
On the other hand, only two percent of all the harm events were on CMS Deficit Reduction Act (DRA) HAC list. For instance, CMS currently counts and includes surgery-related Infections in their list if they involve a colon or abdominal hysterectomy. It implies that other infections, like those that occur after a laminectomy, are not counted or included in the list.
HHS-OIG Recommendations to Improve Hospital Care and Patient Safety
The HHS-OIG report offers three recommendations to CMS and four to AHRQ that could help reduce these harm rates and improve patient safety during hospitalization. The three recommendations to the CMS to reduce patient harm include the following:
- Update and expand its lists of HACs to include Common, avoidable, and high-cost harm events
- Look into expanding the use of patient safety metrics in demonstrations and pilots for medical care payments when necessary
- Create and share interpretive guidelines for usage by surveyors when determining whether hospitals follow the rules for tracking and keeping track of patient harm
On the other hand, the HIS-OIG four recommendations to the Agency for Healthcare Research and Quality (AHRQ) include the following:
- Optimize the Quality and Safety Review System (QSRS) use, including determining the feasibility of automating data collection for national measurement and supporting local use
- Continue efforts to identify and create new approaches to hospital patient harm prevention
- Harmonize the actions of the agency to update agency-specific Quality Strategic Plans
- Create a successful model for the spread of information regarding national Clinical Practice Guidelines (CPGs) or best practices to boost patient safety
Vital Measures that CMS is Currently Considering
In line with the recommendation, CMS declared taking into account the addition of the HAC Reduction Program during the yearly regulatory process for Medicare inpatient payments. The following relevant measures are currently under consideration for the HAC Reduction Program:
- Outcomes of healthcare-related Clostridioides Difficile Infection
- Outcomes of hospital-onset bacteremia and fungemia
- Opioid-associated adverse events
- Severe obstetric complications
Other Strategies to Reduce Patient Harm During Hospitalization
Hospitals, patients, and family members also have a role to play in minimizing patient harm. The following are some actions that hospitals, patients, and families can take to reduce patient harm during hospitalization:
Patients and Family Members
Patients should be involved in their healthcare whenever possible, such as choosing providers based on quality measures. Family members can also look up the patient safety rankings of the hospitals they plan to admit their loved ones. They can check out this information on public or private websites like CMS Hospital Compare.
Furthermore, patients and their families should always feel comfortable approaching nurses and doctors with their concerns and inquiries. They should ask questions concerning medications, staffing levels, and treatment plans. Also, patients and their families should be on high alert while receiving hospital care and other medical attention and raise alarms when necessary.
The Hospital and Staff
On the other hand, hospitals and personnel also have a role to play in reducing patient harm. They must also stress the importance of practices like doctors and nurses washing their hands before and after giving a patient medication to prevent infections.
They should also verify patient names before giving them any medications to avoid medication errors that could result in severe complications. The medical team must collaborate with patients and families to track patient conditions and feel comfortable speaking up on time when issues arise.
Final Thought
Hospitalized patients who suffer harm face many risks, including fatalities, serious complications, and long-term disabilities. Also, patient harm during hospitalization places a financial burden on federal healthcare programs, the patients, and their loved ones. Hospitals and agencies dedicated to patient safety need to put more effort into improving patient outcomes and safety.
