An analysis of more than 7 million recent discharge
records from hospitals in 28 states reveals that a group of
18 medical injuries that occur during hospitalization may
account for 2.4 million extra hospital days, $9.3 billion
in excess charges and almost 32,600 attributable deaths in
the United States annually.
Reporting in the Oct. 8 issue of the Journal of the
American Medical Association, researchers from the
Johns Hopkins
Children's Center and the Agency for Healthcare
Research and Quality found that among the 18 patient safety
events that develop after elective surgery, severe
infection, or sepsis, was the most common treatment-related
injury, occurring in approximately 11 per 1,000 cases.
Sepsis also was associated with the greatest increases in
length of stay (11 days), charges ($57,727) and in-hospital
mortality (22 percent).
"Many studies have examined the prevalence of medical
errors, but this is one of the first studies to provide
significant insight into the adverse effects of particular
medical injuries on patients and health care resources,"
said the study's senior author, Marlene Miller, director of
Quality and Safety Initiatives at the Johns Hopkins
Children's Center. She conducted the research while with
the Agency for Healthcare Research and Quality.
In the study, Miller and her team analyzed discharge
records from 994 hospitals nationwide using the AHRQ's
established Patient Safety Indicators, a set of algorithms
used with administrative data that can help identify
possible medical injuries occurring during hospitalization.
In addition to postoperative sepsis, 17 other Patient
Safety Indicators were used for this study, including
accidental puncture or laceration, postoperative
hemorrhage, complications of anesthesia and postoperative
respiratory failure.
The study used a case-control methodology where each
medical injury case identified was compared with up to four
control patients from the same institution with the same
diagnosis-related group, sex, race and age category. Once
cases of potential medical injuries were identified and
matched, the researchers focused on outcome statistics
relating to length of hospital stay, financial charges and
in-hospital mortality.
Following postoperative sepsis, the second most
serious event was the unintended re-opening of a surgically
closed wound, which was associated with 9.42 extra days in
the hospital, $40,323 in excess charges and 9.63 percent
attributable mortality.
According to Miller, the study has several limitations
related to the reliability of information. "The reliability
and validity of the AHRQ's PSIs depend on the accuracy and
completeness of specific coding of the administrative
data," she said. "Also, the coding system was not designed
to identify medical injuries and, therefore, is not
clinically precise for this purpose. For instance, some
PSIs, such a postoperative hemorrhage, may be in part due
to patient conditions and in part due to failure in
care."
Nevertheless, she added, the findings are strong
enough to suggest that the nation's hospitals "have their
work cut out for them in order to reduce these statistics.
We need to look beyond the numbers to find the root causes
of medical errors so we can prevent them, keep hospital
costs down and ultimately provide the safest possible care
for patients."
Chunliu Zhan, of the AHRQ, was a co-author of this
study.
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