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Medical-errors gap widens between best and worst hospitals: Healthgrades study

02.05.2005

- Three-Year Study Covers 37 Million Hospitalizations, Uses AHRQ Indicators -

- Nation’s Safest Hospitals, Identified in Study, Tend to Have "Culture of Safety" -

- Cost to Medicare of Patient Safety Incidents: $3 Billion Annually -

- Hospital-Acquired Infections Grow, Prove Costly -

Patient safety incidents at America’s hospitals increased slightly, but the nation’s safest hospitals grew even safer, resulting in a wider gap in patient safety incident rates among the nation’s best and worst hospitals, according to a new study of 37 million patient records released today by HealthGrades, an organization that evaluates the quality of hospitals, physicians and nursing homes for consumers, corporations, hospitals and health plans.

The second annual HealthGrades Patient Safety in American Hospitals Study finds that 1.18 million patient safety incidents occurred among Medicare hospitalizations in the years 2001, 2002 and 2003, with the cost to Medicare approaching $3 billion annually. That compares with 1.14 million incidents in the three years beginning with 2000.

The study also finds that hospital-acquired infections grew by 20% and accounted for 30% of the costs of patient safety incidents.

"The reason we see the hospitals with the lowest incident rates improving the fastest is that they have what I call a ’culture of safety’," said HealthGrades Vice President of Medical Affairs Samantha Collier, M.D., who authored the study. "A ’culture of safety’ requires rapid identification of errors and root causes and the successful implementation of improvement strategies, which can only be achieved with strong leadership, critical thinking, and commitment to excellence. For patients, it’s important to know which hospitals meet this standard, as they are nearly 50% less likely to have an incident at hospitals in the top 10%, according to the HealthGrades study."

The study, which applies 13 patient safety indicators (PSIs) identified by the Agency for Healthcare Research and Quality (AHRQ) to Medicare hospitalizations, produced the following findings:

There were wide, highly significant gaps in individual PSI and overall performance between the top10% and the bottom 10% ranked hospitals.
Top 10% hospitals generally had lower incident rates across all PSIs in 2001, but also generally improved at a greater rate than the bottom 10% hospitals between 2001 and 2003.
Overall, from 2001 through 2003, the best-performing hospitals as a group (hospitals that had the lowest overall PSI incident rates of all hospitals studied, defined as the top 10% of all hospitals studied) had 267,151 fewer patient safety incidents and 48,417 fewer deaths resulting in a lower cost of $2.3 billion associated with Medicare beneficiaries as compared to the bottom 10% of all hospitals studied.
Patients in the top 10% hospitals had, on average, on average 50 percent lower occurrence of experiencing one or more PSIs compared to patients at the bottom 10% hospitals. Important and frequent contributors to this notable difference were significantly lower rates of hospital-acquired infections and post-operative metabolic derangements.
If the bottom 10% hospitals improved only their hospital-acquired infection rates to the level of top 10% hospitals, 2,734 deaths associated with $792 million could have been avoided from 2001 through 2003.
The rates of six key quality improvement focus areas (metabolic derangements, post-operative respiratory failure, decubitus ulcer, post-operative pulmonary embolus (PE) or deep vein thrombosis (DVT), and hospital-acquired infections) worsened on average by 20 percent or more over four years (2000 through 2003), while another six PSIs (death in low mortality DRGs, failure to rescue, iatrogenic pneumothorax, post-operative hip fracture, post-operative hemorrhage or hematoma, and post-operative wound dehiscence) improved on average by less than 10 percent.
Of the total of 302,541 deaths among patients who developed one or more PSIs during 2001 through 2003, 81 percent (n=245,008) of these deaths were attributable to the patient safety incidents.
Hospital-acquired infections correlated most highly with overall performance and performance on the other 12 PSIs, suggesting that hospital-acquired infection rates could be possibly used as a proxy of overall hospital patient safety.
Hospital-acquired infections rates worsened by approximately 20 percent from 2000 to 2003 and accounted for 9,552 deaths and $2.60 billion, almost 30 percent of the total excess cost related to the patient safety incidents.
The 16 PSIs studied accounted for $8.73 billion in excess inpatient cost to the Medicare system over the three years studied, or roughly $2.91 billion annually.

"We found that that highest incidence rates were in the categories of Failure to Rescue, Decubitus Ulcer and Post-Operative Sepsis," continued Dr. Collier. "Since HealthGrades’ first Patient Safety study in 2004, which identified Failure to Rescue as a major source of patient safety issues, we were gratified to see the Institute for Healthcare Improvement advocate for -- and providers begin to adopt -- protocols for minimizing these events."

Distinguished Hospital Awards and Findings

Based on the study, HealthGrades identified 135 hospitals falling into the top 10% in the nation in terms of patient safety, qualifying them to receive the HealthGrades Distinguished Hospital Award for Patient SafetyTM. The award was designed to highlight hospitals with the best records of patient safety in the nation and to encourage consumers to research their local hospitals’ patient-safety records before undergoing a procedure.

Methodology

The study is based on 13 of AHRQ’s patient safety indicators, applied to the most recent MedPar file of Medicare admissions at nearly 5,000 hospitals covering 2001, 2002 and 2003. Teaching hospitals and non-teaching hospitals were evaluated separately, based on a recommendation from AHRQ that hospitals be compared to their peer group. All data was risk adjusted, so that hospitals with sicker patient populations could be compared equally with others.

The 13 AHRQ indicators are: