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April 2008

Month in "Focus": April Review

April was a month marked by several startling statistics, including concerns over potentially flawed CDC numbers, and more movement on the mainstream trend of commercial insurers no longer paying for preventable medical errors (PMEs).   

And, once again, April was a month that delivered too many statistics that are nowhere near where they should be. As those numbers represent lives hurt and lives lost--all due to medical errors that remain preventable.

Here's a wrap-up of what we've been covering over the past month:

Quaid continues to use the spotlight for safety. With the near-death experience of his twin babies last November due to preventable medication errors, Dennis Quaid continues to leverage his celebrity to push for better patient safety practices. At the annual meeting of the Association of Healthcare Journalists Quaid professes, “I’d never allow a friend or a family member ever to be in a hospital alone." More on that here.

No age is safe from errors, even our nation's newborns. Speaking of Quaid's baby trauma, the problem is far worse than we thought--a new study finds 11 per cent of hospitalized children in the U.S. were given wrong drugs or accidental overdoes. Researchers also noted that 22 per cent of these medical errors were preventable. More information here.

Deaths and costs continue to rise. In their fifth annual Patient Safety in American Hospitals Study, Health Grades Inc., cites that errors in treatment resulted in 238,337 potentially preventable deaths of Medicare patients in the US, costing $8.8 billion. Learn more at this link.

Medicare and Medicaid go no-pay as costs spiral out of control. An interesting article from April 14th cites the growing costs of preventable medical errors and the aggressive steps that public (Medicare and Medicaid) and private insurers are taking to decrease hospital reimbursements as an incentive for increasing safety. More on that right here.

Continue reading "Month in "Focus": April Review" »

Bay Area Hospital 'Collaborative' Succesful in Reducing HAIs, Saving Lives

Silicon Valley Business Journal delivers some much-needed, good news on Hospital-Acquired Infections (HAIs). According to the April 22nd article:

"The Beacon Collaborative, a voluntary affiliation of 39 hospitals in five San Francisco Bay Area counties, said Monday that its members reduced the number of two major types of hospital infections dramatically between April 2006 and the end of last year, saving an estimated 194 lives in the process.

Hospitals participating in the voluntary effort are located in five Bay Area counties: San Francisco, Alameda, Marin, San Mateo and Santa Clara.

During the 21-month period, 34 of the 39 hospitals in the group prevented an estimated 60 percent of the cases of ventilator-associated pneumonia (VAP) that otherwise would have been expected, and an estimated 66 percent of cases of central line-associated bloodstream infections (CL-BSI), two of the most common types of so-called hospital-acquired infections. Approximately 720 infections were likely prevented, saving an estimated 194 lives and nearly $4 million in unnecessary hospital costs."

Nationally, VAP infections account for more than 35,000 deaths a year, at an average cost of nearly $10,000 per infection, and CL-BSI cases result in as many as 21,000 deaths, at an average cost of more than $36,000 per infection, according to Centers for Disease Control and Prevention data cited by the Beacon group.

It is indeed inspiring to hear how, in working together, some positive new milestones are being achieved. Especially since those milestones equate to lives saved. We hope to continue to bring more positive news in the fight against HAIs--including more success in better hand hygiene, prevention of falls, super bugs and bed sores.

Full article located here.

CDC Data Flawed, Regulations Too Lax?

In taking a strong stance with the CDC through an April 15th Commentary in The Washington Times before her testimony to Congress, Betsy McCaughey, Chairman of The Committee to Reduce Infection Deaths (RID), writes:

"Tomorrow Congress will hold hearings on whether the federal government is doing enough to prevent deadly hospital infection. The answer is 'no.' The biggest culprit is the CDC. The CDC claims 1.7 million people contract infections in U.S. hospitals each year. The truth is several times that number."

MCaughey then discusses the growing numbers of MRSA and how that alone skews the CDC's numbers:

One of the fastest growing infections is "Mersa" or MRSA, which stands for methicillin-resistant Staphylococcus aureus, a superbug that doesn't respond to most antibiotics. In 1993, there were fewer than 2,000 MRSA infections in U.S. hospitals. By 2005, the figure had shot up to 368,000 according to the Agency for Healthcare Research and Quality. By June, 2007, 2.4 percent of all patients had MRSA hospital infections, according to the largest-ever study, published in the American Journal of Infection Control. That would mean 880,000 victims a year.

That's from one superbug. Imagine the number of infections from bacteria of all kinds, including such killers as VRE (vancomycin-resistant Enterococcus) and C. diff (Clostridium difficile). Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, recently told Congress that MRSA accounts for only 8 percent of hospital infections.

These new facts discredit the CDC's official 1.7 million estimate. CDC spokeswoman Nicole Coffin admits "the number isn't perfect." In fact, it is an irresponsible guesstimate based on a sliver of 6-year-old (2002) data. The CDC researchers who came up with it complained that not having actual data 'complicated the problem.'

Numbers matter. Health conditions that affect the largest number of people generally command more research dollars and public attention."

McCaughey's column is compelling and points a very strong finger at the CDC to (1) provide up-to-date, accurate data on this (preventable!) epidemic and (2) increase the protocols to be in line with those of other countries who have eradicated the problem (as Europe has with MRSA screening). She also draws correlations to other government regulators, noting:

"It is common for government regulators to become soft on the industry they are supposed to regulate. A coziness develops. Federal Aviation Administration inspectors failed to insist on timely electrical systems inspections, say news reports. The same may be true at the CDC, where government administrators spend too much time listening to hospital executives and not enough time with grieving families."

The current statistics on hospital-acquired infections (HAIs) are already mind-numbing...but to think that there are far higher, and far more that we could be doing makes McCaughey's voice one of the most important in the fight on preventable medical errors.

 Full piece located here. A transcript of McCaughey's address to Congress can be downloaded here (PDF).

Key Challenges in the Fight Against HAIs

In her April 18th post, columnist Kristen Gerencher hits on the key challenges in the fight against Hospital Acquired Infections (HAIs). As she writes in her opening:

"It’s the invisible threat that lurks whenever you stay in a hospital: hospital-acquired infections, the potentially dangerous bugs that can be spread around the facility when doctors, nurses and staff fail to wash their hands, sterilize medical equipment or take appropriate precautions with high-risk patients. The infections are especially sneaky because most symptoms show up after you leave the hospital, typically within 30 days of being discharged."

The piece hits on these key issues:

  • More accountability needed. The U.S. Government Accountability Office (GAO) weighed in this week on the state of hospital infections in a report that urged the Department of Health and Human Services to play a bigger role in overseeing recommended practices for countering infections. The GAO has called for linking the four databases used to collect information on hospital infections to get a more consistent and national picture of the problem.
  • Fatalities and injuries continue to startle. Almost 100,000 people die from hospital infections every year, making the bugs the sixth leading cause of death in the U.S. About 2 million Americans get hospital-acquired infections every year, with some patients making a full recovery and others battling invasive infections for years. (more statistics provided here)
  • Costs are out of control, and likely underreported. Nationwide, a standard estimate is that hospital infections cost $5 billion to $6 billion a year--but that number is likely to be much higher because that figure is 10 years old.
  • Everyone needs to be on-board with safety initiatives. Next year New York will begin mandating the state’s hospitals to disclose the ratio of infection-control professionals per bed. But, according to Lisa McGiffert, Austin, Texas-based manager of Consumers Union’s Stop Hospital Infections, "A good number to aim for is 1 per 100. In order to control infections, you have to have a well-organized program that involves everyone in the hospital.”

Currently, 22 states require hospitals to report their infection rates. Several bills in Congress are  working to create a set of national reporting standards and requirements and impose a mandated ratio of infection-control professionals per number of hospital beds.

According to Gerencher's piece, "Some states have been leading the push as well. Pennsylvania now requires hospitals to report the incidence of all four major types of infections and screen for an antibiotic-resistant bug known as MRSA."

The recent no-pay policies by Medicare/Medicaid for preventable medical errors, along with Insurers no longer covering them should serve as strong motivation to today's hospitals but clearly, we have a long road ahead of us.

Full post located here.

"No Pay" Policies Now Mainstream

Along with Aetna and Wellpoint, Anthem Blue Cross and Blue Shield and Medicare and Medicaid, now CIGNA insurance will no longer reimburse hospitals for preventable medical errors (PMEs). These reimbursements currently pertain to "never events"--which are errors in patient care that can and should be prevented, like operating on the wrong area and administering the wrong blood type (learn more about "never events" here).

The policy will become effective as of October 1, 2008 and, according to CIGNA, CIGNA is committed to improving quality for our members throughout the health care system,  said Jeff Kang, MD, chief medical officer for CIGNA HealthCare. Our policy on never events and avoidable hospital conditions is designed to put patient safety first and to encourage hospitals to improve quality  every day, one patient at a time.    

Helen Darling, president of the National Business Group on Health, remarked Hospitals, health care professionals and health plans must all work together to ensure that never events never happen, avoidable conditions are always avoided, and every patient receives quality treatment in a safe and caring environment.    

There's now little doubt that "No Pay" policies have hit mainstream...the question now is how long it will take to progress from never events to cover more PMEs.

Full news release located here.

IHI announces two-day seminar focused on improving collaboration as means for improving patient safety

"Teamwork doesn’t always come naturally to health care professionals.  Our cultures too often emphasize autonomy and working within professional boundaries. But the new rules of health care focus on better cooperation and collaboration among and between clinicians."

The above statement is from IHI's two-day seminar--occurring June 10th and June 11th--titled "Delivering Safe and Optimal Care Through Effective Teamwork and Communication". The seminar provides participants strategies and tools for training teams and overseeing the implementation of effective team communication.

Insofar as outcomes, the seminar enables attendees to:

  • Implement practical strategies to create and maintain team communication
  • Implement measures to sustain evidence-based teamwork and communication
  • Utilize practical tools and resources that can be applied in your organization
  • Understand best practices in the field including, tools, structures, and strategies
  • Train others on how to implement teamwork and communication
Designed for organization leaders, patient safety officers, physicians, nurses and risk manager, learn more here.

Hospital Mistakes Getting Costlier

An interesting article from April 14th cites the growing costs of preventable medical errors and the aggressive steps that public (Medicare and Medicaid) and private insurers are taking to decrease hospital reimbursements as an incentive for increasing safety.

According to The Hartford Courant:

"When hospitals botch the quality of patient care, their bottom lines often take a hit as their reputations nosedive, regulatory oversight increases, fines are imposed and lawsuits are filed. Now, making a mistake is getting even costlier as health care insurers and the federal government are penalizing hospitals by axing reimbursements for faulty patient care.

In Connecticut, hospitals are required to report preventable medical errors — termed “adverse events” — to the Department of Public Health and face subsequent investigations and potential fines and mandated procedural changes.

From July 2004 to September 2007, 11 percent of adverse events resulted in death. That means 73 people died because of supposedly “preventable” mistakes.

The Centers for Medicare and Medicaid Services (CMS) got the adverse event movement going among insurers: beginning in October, it will no longer pay to treat nine preventable conditions acquired in a hospital, including falls, certain infections and surgery performed on the wrong patient. According to CMS, hospitals must now absorb the cost of treating the condition and may not bill the patient.

The point, CMS said, is that implementing such a provision will give hospitals a financial incentive to take steps to prevent conditions that should never occur in a hospital. Plus, CMS estimates that the move will save Medicare $20 million in FY 2009."

As we've covered in recent months, insurance companies' Aetna and Wellpoint have established "no-pay" policies for preventable medical errors. And, as recently as this month, Anthem has followed suit. There's no doubt that patient safety is increasingly moving into the public discourse.

Moreover, with Medicare/Medicaid and private insurance companies establishing no-pay policies, and patient safety groups like Health Grades publishing reports that cite $8+billion in costs from preventable medical errors, the heat is on hospitals more than ever before to adopt better practices and protocols.

But amid these problems there are proven solutions. And these solutions--focused wholly on prevention--can be implemented immediately.

IHI has created outstanding protocols, Leapfrog is pushing for more transparency and accountability and we have created 24/7, non-intrusive monitoring systems. Efforts and services such as these increase the level of care and decrease preventable medical errors--and in turn, the exhaustive dollars spent on them.

Full article here.

Study Reveals Startling Statistics: 1 out of 10 children harmed by hospital drug errors

A new study found 11 per cent of hospitalized children in the U.S. were given wrong drugs or accidental overdoses. Researchers also noted that 22 per cent of these medical errors were preventable.

While we've been covering celebrity-turned-patient-safety advocate Dennis Quaid's Crusade with patient safety--and the incidents with his newborns being accidentally overdosed--a study is shining light that points to preventable medication errors in newborns as a MUCH larger issue than once thought. The new study found about 11 per cent of hospitalized children in the U.S. were given wrong drugs, or too much of a certain drug.

According to Digital Journal: "Published in the April issue of Pediatrics, the study  (PDF located here) reported 11 drug-related harmful incidents for every 100 hospitalized children. That new statistic is much higher than the earlier estimate of two per 100 hospitalized kids. According to government data, the new data reveals medical errors affecting roughly 540,000 kids per year.

The study’s authors, largely from Children's Hospital Los Angeles, also wrote: Most adverse drug events resulted in temporary harm, and 22 per cent were classified as preventable. "

Full post here. PDF of full study located here

More Insurers Say "No Pay" to PMEs

A few months back we asked if the tides were turning. Now it appears those waves are gaining momentum.  No longer isolated to Insurance Companies' Aetna and Wellpoint, Anthem Blue Cross and Blue Shield in New Hampshire announced Thursday that it will no longer pay for Preventable Medical Errors (PMEs).

According to the article: "Anthem called the move an initiative aimed at working toward eliminating preventable major adverse medical events in order to lower health care costs.

From the standpoint of Donna Fitts, the vice president of Quality and Risk Systems at Portsmouth Regional Hospital, this decision by a major insurance carrier will have a positive impact on hospitals across the state, including her own. 'It will force us, in a very busy medical environment, to stop and take stock of the things we do,' Fitts said. 'It is crystal clear that many of these things are errors that should never occur in a hospital."

According to Anthem: "The primary focus of these efforts will be to ensure that physicians and hospitals are using appropriate processes, technologies and strategies to address 'never events' and, ultimately, to enhance the quality of care delivered to hospitalized patients," said Richard Lafleur, M.D., medical director, Anthem Blue Cross and Blue Shield in New Hampshire. 'We continue to work collaboratively with physicians and hospitals to analyze why and how these events occur, and to proactively find ways to improve patient safety and clinical care.'

In addition to improving patient safety and quality outcomes, Lafleur added that the initiative will help protect Anthem's members from additional costs resulting from medical errors. 'As a strong advocate for patient safety, we have a responsibility to our members to work with our hospital partners to put processes in place that focus on preventing these events,' said Lafleur."

Full article here.

Health Grades' Report Cites 238,000+ Preventable Deaths, $8+ Billion In Preventable Costs

In their fifth annual Patient Safety in American Hospitals Study, Health Grades Inc., cites that errors in treatment resulted in 238,337 potentially preventable deaths of Medicare patients in the US, costing $8.8 billion.

HealthGrades Inc. analyzed over 41 million patient records for the study and found that approximately 3 percent of all Medicare patients suffered from some medical error-- which equates to about 1.1 million Patient Safety Incidents (PSIs) from 2004-2006. In the report, Health Grades describes medical errors as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim…[including] problems in practice, products, procedures, and systems."

There were 270,491 actual in hospital deaths that occurred among patients who developed one or more of 16 PSIs and the report states, "Using previous research, we calculated that 238,337 were attributable to patient safety incidents and potentially preventable."

In a prepared statement, HealthGrades' chief medical officer and primary author of the study, Dr. Samantha Collier, said "While many U.S. hospitals have taken extensive action to prevent medical errors, the prevalence of likely preventable patient safety incidents is taking a costly toll on our health care systems -- in both lives and dollars", she continues, "HealthGrades has documented in numerous studies the significant and largely unchanging gap between top-performing and poor-performing hospitals. It is imperative that hospitals recognize the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost."

Starting October 1st, the federal Centers for Medicare and Medicaid Services will stop reimbursing hospitals for the treatment of eight major preventable errors, including objects left in the body after surgery and certain kinds of post-surgical infections. As we covered recently, many insurance agencies have already stopped reimbursing for such errors.

Full report by Health Grades is located here (PDF).

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