An Epidemic of Health Care Harm

From Consumer Reports (http://www.consumerreports.org/cro/magazine/2012/08/how-safe-is-your-hos...):

Hospitals should be places you go to get better, but too often the opposite happens.

Infections, surgical mistakes, and other medical harm contribute to the deaths of 180,000 hospital patients a year, according to projections based on a 2010 report from the Department of Health and Human Services. Another 1.4 million are seriously hurt by their hospital care. And those figures apply only to Medicare patients. What happens to other people is less clear because most hospital errors go unreported and hospitals report on only a fraction of things that can go wrong.

“There is an epidemic of health-care harm,” says Rosemary Gibson, a patient-safety advocate and author. More than 2.25 million Americans will probably die from medical harm in this decade, she says. “That’s like wiping out the entire populations of North Dakota, Rhode Island, and Vermont. It’s a man-made disaster.”

“Hospitals haven’t given safety the attention it deserves,” says Peter Pronovost, M.D., senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore. Nor has the government, he says. “Medical harm is probably one of the three leading causes of death in the U.S., but the government doesn’t adequately track it as it does deaths from automobiles, plane crashes, and cancer. It’s appalling.”

“Hospitals that volunteer safety information, regardless of their score, deserve credit, since the first step in safety is accountability,” says John Santa, M.D., director of the Consumer Reports Health Ratings Center. “But the fact that consumers can’t get a full picture of most hospitals in the U.S. underscores the need for more public reporting.”

Here are some of the most important findings from our analysis:

Bad things happen in all hospitals, but they happen a lot in some. The lowest-­scoring hospital, Sacred Heart Hospital in Chicago, earned just a 16 on our 100-point safety scale and reported a rate of bloodstream ­infections that was more than twice the national benchmark. The hospital declined to comment.
Even high-scoring hospitals can do better. Billings Clinic in Montana was at the top of our list—but it got a safety score of just 72. “The work is hard,” says Mark Rumans, M.D., the hospital’s physician-in-chief. “We are far from perfect.”
Some well-known hospitals have less-than-outstanding safety scores. That includes Massachusetts General Hospital, Boston, with a safety score of 45; Ronald Reagan UCLA Medical Center, Los Angeles, 43; Cleveland Clinic, 39; New York-Presbyterian, New York, 32; and Mount Sinai Medical Center, New York, 30.
Our Ratings are an important measure, but they’re not the only source you should consult. They don’t, for example, assess how successful hospitals are at treating medical conditions. So before a planned hospital stay, consult multiple sources, such as Hospital Compare, run by the federal government, and the Leapfrog Group, an independent organization that tracks hospital safety and quality. Some of the data we use come from those sources.

Despite worsening back pain, Patrick Roth of Dartmouth, Mass., loved to ride his bicycle. But that was before back surgery in 2007 at age 65. The procedure was followed by several complications, including an infection with a potentially deadly bacterium. Roth says he didn’t understand he had the infection until he transferred to a new hospital. Now he rides a mobility scooter instead of a bike and is learning to live with the side effects of daily antibiotics, he says.

An estimated 290,000 surgical-site infections occur each year in U.S. hospitals, and Roth’s is an example of the agony they can cause. A few days after his surgery Roth was in so much pain he had to return to the hospital. He was there for 12 days, most of which he can’t remember because of the pain medication he was given. (Roth was initially treated at Carney Hospital in Boston. We don’t have data for the period he was hospitalized. But the hospital received a 61 in our current safety score and top marks for avoiding infections.)

Roth’s wife, Barbara, says he was hallucinating and “would scream for 2 to 3 hours at a time.” A CT scan taken several months later showed that a screw from his surgery had broken, but Roth says his doctors don’t want him to risk another operation. He can no longer walk unassisted. “The pain becomes too intense,” he says. And to this day the Roths have not received “even an acknowledgment or an apology for what he went through,” Barbara Roth says. The hospital said it could not comment on a specific patient.

Only 544 of the hospitals in our Ratings have data for surgical-site infections, from 14 states that require their public reporting. Of those hospitals, 82 reported zero such infections.

But more needs to be done. “Those carrots are fine, but we need some sticks, too,” says Lisa McGiffert, director of the Safe Patient Project at Consumers Union, the advocacy arm of Consumer Reports. For example, Medicare withholds payments for some procedures that lead to patient harm, but it should also require hospitals to pay for the follow-up tests and treatments that those errors lead to, she says.

Consumers Union believes that a national system should track and publicly report medical errors. The Institute of Medicine recommended that more than a decade ago. “The public assumes that someone keeps track of all that goes wrong, but that is just not the case,” McGiffert says.

8 things that should never happen in a hospital

There’s never an excuse for operating on the wrong patient or body part. But our medical experts say that several less dramatic events should also never or at least very rarely occur in hospitals. Those include the complications listed below, which are part of our Ratings.

1. Bedsores. These painful wounds, usually on the ankles, back, buttocks, hips, or other bony areas, can develop if a patient is left in one position too long. Frequent repositioning and special pads, cushions, and mattresses can prevent them. If you see early signs, including patches of skin that have reddened, let the nursing staff know.

2. Collapsed lungs. If doctors are not careful, they can puncture the lungs when inserting a catheter or needle into the chest. Your doctor should use an ultrasound as guidance, especially if you’re at high risk because of chronic lung disease.

3. Central venous catheter-related bloodstream infections. A doctor or nurse should make sure that these tubes, used to deliver medicine and nutrients, are kept clean and are removed as soon as they’re no longer necessary.

4. Postoperative hip fractures. To prevent a fall that can break your hip, ask for help when you get out of bed. And don’t take more pain medication than you need or walk if you are groggy.

5. Blood clots after surgery. Some surgeries, such as those to replace a hip or knee, can cause blood clots to form in the legs. Those clots can break loose and travel to the lungs, a deadly complication called a pulmonary embolism. Moving about and walking soon after surgery can help prevent the clots, as can blood thinners and special stockings.

6. Postoperative sepsis. This occurs when a serious infection overwhelms the body, leading to failure of the kidneys, liver, lungs, and other organs. Make sure that everyone who touches you washes their hands and that the hospital follows infection-prevention guidelines. Early signs include either high or low body temperature plus rapid breathing and pulse. Treatment includes measures to rein in the infection and control blood pressure.

7. Opening of a wound after surgery. A wound that opens in the days following an operation is an infection waiting to happen. Ask how to care for your surgical wound, how long it should take to heal, and what to do if it doesn’t.

8. Accidental punctures or cuts. Surgeons can accidentally puncture or cut an organ or blood vessel, which can extend your hospital stay. Finding an experienced, skilled surgeon might reduce the risk.

My comment:

The Utah Healthcare Initiative has long advocated for mandatory reporting of patient safety problems with public health follow up for fatalities and significant injuries. What else makes sense given the enormous size of this problem? This is one of the three most common causes of death in the United States? Would we tolerate a similar poor safety record in the airline industry?

Dr. Joe Jarvis