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Hospital Acquired Conditions, Patient Safety Hold Steady in 2014

After a significant drop in HACs at the start of the decade, patient safety gains appear to be leveling off in the nation's hospitals.

By Jennifer Bresnick

- Key hospital quality and patient safety metrics, including the rates of hospital acquired conditions (HACs), certain infections, and adverse drug events (ADEs), have not seen significant change from 2013 to 2014.  However, these events remain well below previous levels, according to the newest interim data from the Agency for Healthcare Research and Quality (AHRQ).

Hospital quality and patient safety

Since 2010, hospital acquired conditions have dropped by 17 percent, resulting in approximately 87,000 fewer patient deaths and a cost savings of nearly $20 billion. 

The latest data shows that hospitals are capable of maintaining these gains in patient safety, despite worries that regulatory overload, medical device integration problems, and EHR usability woes are making it increasingly difficult for hospital staff to operate efficiently.

“Cumulatively, approximately 2.1 million fewer incidents of harm occurred in 2011, 2012, 2013, and 2014” when compared with incidents in 2010, AHRQ says in its report. 

Approximately 40 percent of these gains can be attributed to fewer adverse drug events, while 28 percent is related to a reduction in pressure ulcers and 16 percent resulting from fewer catheter-associated urinary tract infections. 

Other HACs incorporated into the metrics include central line-associated bloodstream infections, patient falls, surgical site infections, ventilator-associated pneumonia, and post-operative venous thromboembolisms.

“Interim 2014 estimates indicate that more than 36,000 fewer patients died in hospitals in 2014 as a result of the decline in HACs compared with the number of deaths that would have occurred if the rate of HACs had remained steady at the 2010 level,” the report continues. 

A reduction in adverse drug events and pressure ulcers comprise the majority of these gains.

In addition to saving lives, hospitals have been dramatically slashing costs.  Since 2011, the nation’s hospitals have saved more than $10 billion in spending due to pressure ulcer reductions alone.  Fewer ADEs have resulted in $4.2 billion in savings, while a cut in surgical site infections has produced over $1.3 billion in averted costs.

Savings in 2014 alone totaled approximately $7.8 billion, similar to figures produced in the previous year.

AHRQ does not pinpoint a specific cause for the gains, stating that the “reasons for this progress are not fully understood.” 

Perhaps tellingly, the Agency makes few mentions of the role that EHR adoption, clinical decision support, and improved predictive analytics might play in these improvements.  In a footnote at the end of the report, the authors cite an unrelated paper hinting that “one may hypothesize” about the positive correlation of health IT adoption and patient safety improvements.

Instead, AHRQ lavishes praise on regulatory programs and its own efforts to spur systematic improvement through better data collection and more accurate measurement.

“Likely contributing causes are financial incentives created by CMS and other payers' payment policies, public reporting of hospital-level results, technical assistance offered by the Quality Improvement Organization (QIO) program to hospitals, and technical assistance and catalytic efforts of the HHS Partnership for Patients (PfP) initiative led by CMS,” the brief says.

“And crucially, the progress was made possible by the results of investments made by the Agency for Healthcare Research and Quality in producing evidence about how to make care safer, investing in tools and training to catalyze improvement, and investments in data and measures to be able to track change.”

The report also notes that additional public and private patient safety initiatives, as well as value-based reimbursement programs, are likely to have had a hand in raising quality over the past few years. 

Despite the laudable progress, “there is still much more work to be done, even with the 17 percent decline in the HACs we have measured for the PfP since 2010,” the study concludes. “The Interim 2014 HAC rate of 121 HACs per 1,000 discharges is the same as was seen in 2013, and it means that in 2013 and 2014 almost 10 percent of hospitalized patients experienced one or more of the HACs we measured. That rate is still too high.”

While the data indicates that it is possible to create and sustain patient safety improvements across the board, healthcare organizations, rule makers, and other industry stakeholders must continue to push towards even greater gains in an effort to create a safe and high-quality patient care environment.

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