Nearly 1 in 4 U.S. hospital patients experience a harmful event, study finds

Nearly one in four patients admitted to a hospital in the United States will experience harm, according to a study published Wednesday in the New England Journal of Medicine.

The startling results underscore that, despite decades of effort, hospitals in the United States still have a long way to go to improve patient safety, experts say.

“These numbers are disappointing, but not shocking,” said Dr. David Bates, chief of general medicine at Brigham and Women’s Hospital in Boston, who led the study. “They show that we still have a lot of work to do.”

The research examined the medical records of 2,809 patients hospitalized at 11 Boston-area hospitals in 2018. The study excluded those admitted for observation only, hospice, rehabilitation, drug treatment or psychiatric care.

Hospital data showed that 663 of these patients – about 24% – experienced at least one event during their stay that negatively affected their health, even temporarily.

A total of 222 adverse events were considered preventable, meaning that an error resulted in harm to the patient. This translates to about 7% of the total admissions analyzed by the researchers. Twenty-nine people, or 1% of the total admitted people, experienced preventable serious adverse events that resulted in serious harm. One death was considered preventable.

The majority of poor outcomes, however, were deemed unavoidable. These may include known side effects of certain medications or known risks associated with surgery.

Overall, the most common adverse events (nearly 40%) were related to medications administered in the hospital. Surgery and other procedures accounted for just over 30%, followed by what the study authors called “patient care events” at 15%. These include falls and pressure sores, both of which are considered preventable.

A bright spot, experts said, was that hospital-acquired infections accounted for only about 12% of adverse events – a significant decrease from a 1991 study that found infections to be the second most common adverse event. more frequent.

This 1991 study, called the Harvard Medical Practice Study I, is considered landmark research. He used data from hospitalized patients in New York State in 1984 and found that only about 4% of hospitalized patients experienced harm. However, the study looked for a narrower range of adverse events than current research, and hospitals have become much better at reporting harm when it occurs.

“Clearly at least the rate isn’t going down and damage continues to be a very serious issue,” Bates said.

Dr. Albert Wu, director of the Center for Health Services and Research Outcomes at the Johns Hopkins Bloomberg School of Public Health, said in an email that while progress has been made in some areas, new risks have emerged as medicine progressed.

“Although we eliminated some causes of harm, new types of harm were created, associated with powerful new drugs and new procedures,” said Wu, who was not involved in the new research.

For example, pharmaceutical companies have made significant progress in the three decades since the last report was published, but with an abundance of drugs available, the chances of medication errors are increasing.

“There are many more drugs available today compared to 1991, and some of them have a smaller therapeutic margin, which is the gap between the therapeutic effect and the dangerous dose,” said Dr. Donald Berwick, President Emeritus and Principal Investigator at the Institute. for better health care in Boston. Berwick wrote an op-ed that was published alongside the new study on Wednesday.

Even technologies implemented to prevent medication errors can create new opportunities for accidents.

“New technologies are always a double-edged sword and it takes intense surveillance to monitor them. You have to anticipate what can go wrong and build levees around hazards,” Berwick said.

Linda Aiken, a professor and founding director of the Center for Health Outcomes and Policy Research at Penn Nursing in Philadelphia, said staffing is at the heart of the patient safety issue.

“Since we’ve been researching patient safety, we’ve consistently found that one of the main explanations for poor patient outcomes is an insufficient number of bedside nurses,” she said. “Having a sufficient number of nurses is a basic element for safety.”

In a 2018 study published in the journal Health Affairs, Aiken and his team surveyed nurses at 535 hospitals in the United States. Sixty percent said there were not enough nurses in their hospital to provide safe patient care. The pandemic has exasperated already stressed healthcare workers, leading to strikes.

Only one state, California, has legal criteria regarding the minimum number of personnel needed for security in a hospital. A nurse cannot care for more than five patients at a time.

“If you implement a standard like this, you could save many lives that are a matter of patient safety,” Aiken said. These are preventable, but there are too few nurses to provide the type of care that would prevent these adverse events from occurring.

Experts said efforts must also be made to prevent damage that has been classified as unavoidable.

“Practices are changing so that unavoidable errors can be avoided through changes in practice,” Wu said. “For example, if you completely stop using a drug that [has a] high rate of unavoidable side effects, these side effects will no longer occur.

Dr. Peter Pronovost, director of quality and clinical transformation at Cleveland University Hospitals, worked on preventing bloodstream infections, which were once considered “inevitable rather than preventable.”

“When we changed that narrative and used checklists, we reduced those infections that were killing more people than breast or prostate cancer by 80 percent,” he wrote in an email.

Wu said patients should “keep in mind that there is a risk of harm while in hospital.” He encouraged patients to strive to be an integral part of their healthcare team, telling hospital workers about the diagnosis they have, the medications they take, the allergies they have and the care they receive. they received elsewhere.

“If you think something is wrong, speak up!” he said.

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