Over the past several years, hospitals have made substantial progress in reducing harm to patients but many challenges still remain, according to an opinion piece published in JAMA.
According to the article, analysis of the Medicare Patient Safety Monitoring System (MPSMS) data from 2005 to 2011 showed that the rate of adverse events declined by approximately 8% and 5% per year for Medicare patients hospitalized for acute myocardial infarction and congestive heart failure, respectively. The numbers did not change significantly for patients hospitalized with pneumonia or for major surgery. The authors noted that the MPSMS is the only source of reliable nationwide estimates on a broad range of patient harms but that it is still limited since it is restricted to Medicare beneficiaries.
The authors went on to examine data from the Agency for Healthcare Research and Quality (AHRQ), which showed that the rate of adverse events among all hospitalized adults dropped from 145 events per 1000 hospitalizations in 2010 to 121 events per 1000 hospitalizations in 2014. This translates an approximately 4.5% decrease in adverse events per year. The AHRQ report included a broad range of adverse events, including medication-related events, falls, central line-associated bloodstream infections, pressure ulcers, etc. However, the AHRQ analysis is based on a review of the medical record rather than administrative data, and the report was not published in a peer-reviewed journal, raising concerns about the validity of the estimates.
“Despite the progress made to date, much work remains to be done,” said the authors. They suggested 4 possible ways to make further progress: 1) gather additional evidence by investing in programs that support patient safety research; 2) create better tools to make improving safety easier and support implementation of those tools; 3) create more reliable and less burdensome ways to measure adverse events; and 4) ensure that improving safety is a high priority for hospital boards of directors, CEOs, and senior leadership teams.
- Kronick R, Arnold S, Brady J. Improving safety for hospitalized patients. JAMA. Published online June 13, 2016. doi:10.1001/jama.2016.7887.