CLEVELAND, Oct. 7 (UPI) -- A new study of hospital-related injuries suggests worries about patient safety have been well founded: Injuries ranging from post-surgical infections to re-opening wounds kill about 32,000 Americans every year and add more than $9 billion to the nation's healthcare bill.
Moreover, those numbers are "just the tip of the iceberg," Dr. Chunliu Zhan, a research fellow at the Agency for Healthcare Research and Quality in Rockville, Md., told United Press International.
Hospital injuries can range from relatively minor mishaps that "don't increase hospital stay or cause any real harm," Zhan explained, "to more serious injuries such as post-surgical sepsis, which increases the risk of dying in the hospital by 22 percent." Zhan, along with Dr. Marlene Miller of Johns Hopkins University in Baltimore, conducted the research, published in the Oct. 8 issue of the Journal of the American Medical Association.
A single case of serious the post-operative blood infection called sepsis adds about $58,000 in costs and 11 days to a hospital stay, Zhan said. The condition called dehiscence -- an accidental opening of a sutured incision -- also can extend a hospital stay by more than nine days and add about $40,000 to the bill.
Although rates of injury associated with childbirth are high -- about 20 percent of births using instruments will result in injury to either mother or the baby -- those injuries are rarely significant. Usually these injuries "do not extend hospital stay and don't add to hospital costs," Zhan said.
The findings are based on analyses of almost 7.5-million hospital discharge records. Zhan and Miller examined the records -- culled from hospitals in 28 states -- to identify 18 specific types of medical conditions. They determined the outcome for each condition, such as post-surgical sepsis or infection due to medical treatments.
Dr. Saul Weingart, director of patient safety at Boston's Beth Israel Medical Center and an assistant professor of medicine at Harvard Medical School, said this "administrative approach (provides) big numbers, but it doesn't really tell us much about the nature of injury. Was it caused, for example, by medical error or is it a case of bad things happening in the course of good medical care?" Weingart co-authored an editorial that was also published in JAMA.
Weingart told UPI he suspects the study "grossly underestimates both the occurrence of injury and the cost of these injuries." One reason for this underestimation, he said, is the decision by Zhan and Miller to omit all injuries caused by medication errors, which many experts claim is the largest single factor in patient injury.
The study comes three years after the Institute of Medicine issued its landmark report, "To Err Is Human: Building a Safer Health System," which focused attention on medical errors and patient injuries related to those errors. The IOM report claimed medical errors killed more people each year than highway collisions, breast cancer or AIDS. It also estimated the total annual cost to the nation in health care costs, lost wages, and disability was "between $17 billion and $29 billion."
Zhan said the IOM report sounded the alarm, but "didn't provide very much hard data." The new study, he commented, "provides much more robust data to clearly identify the problem, although it does not recommend how to "reduce the number of injuries." Such recommendations must come from additional research, which his agency is conducting, he said. For example, AHRQ investigators are drafting a safety curriculum aimed at reducing hospital errors and injuries, he said.
Meanwhile, AHRQ has put together a list of 20 tips for consumers to help reduce medical errors and injuries. The tips list, available online at ahrq.gov, includes specific recommendations for hospital stays. For example, prospective patients should choose a hospital at which many other patients have had the same procedure or surgery.
Also, patients should ask all health care workers with whom they have direct contact whether they have washed their hands.
At discharge, patients should ask their doctor to explain the treatment plan they should follow at home.
The tip list also advises patients to consult with both their doctor and their surgeon, to make sure everyone agrees and is clear about "exactly what will be done."