Care for heart patients shows considerable improvement, but 'bold reforms' still necessary
In 1999, the Institute of Medicine published a shocking report on medical errors that led to in-hospital deaths, noting that as many as 98,000 people per year were dying due to preventable errors.
Now, more than two decades later, are things any better? A team of researchers explored that very questions in JAMA, drawing mostly optimistic conclusions.[1]
To determine whether adverse in-hospital events are on the decline, Noel Eldridge, MS, of the U.S. Department of Health and Human Services, and coauthors looked at data from the Medicare Patient Safety Monitoring System from the years 2010 and 2019. The total number of adverse events dropped from 218 to 139 adverse events per 1,000 discharges for acute myocardial infarction (AMI), and from 168 to 116 adverse events per 1,000 discharges for heart failure, suggesting a significant improvement over time.
“Adverse in-hospital events” included adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events such as hospital-acquired pressure ulcers and falls. Study data represented over 244,000 patients in hospitals all across the country.
In-hospital mortality rates also dropped significantly, declining from 4.6% in 2010 to 2.7% in 2019 for a group of people in the hospital for four categories: AMI, heart failure, pneumonia, and major surgical procedures. The study did not break down mortality rates by category.
In spite of the statistically significant declines, William V. Padula, PhD, of the University of Southern California, and Peter J. Provost, MD, PhD, of Case Western Reserve University, penned an editorial in JAMA lamenting that “the report … is an unfortunate reminder that adverse events remain unacceptably frequent.”[2]
The risk-adjusted decline in adverse events for all four categories, Padula and Provost noted, is just 6% for heart attack patients and 5% for heart failure. In conjunction with the U.S. government’s $282 billion investment in 2019 alone on quality improvement initiatives, the editorial’s authors had hoped to see more substantial gains in patient safety.
“Progress in reducing adverse events cannot be claimed by statistical significance alone," the authors wrote. "Bold reforms are needed through measurement, payment, and hospital reorganization to achieve clinically meaningful outcomes. These changes will not occur until health systems acknowledge they are failing to first do no harm, and that each reported adverse event represents potential morbidity or mortality for individual patients."
Reference:
1. Eldridge N, Wang Y, Metersky M, et al. Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019. JAMA. 2022;328(2):173–183. doi:10.1001/jama.2022.9600
2. Padula WV, Pronovost PJ. Improvements in Hospital Adverse Event Rates: Achieving Statistically Significant and Clinically Meaningful Results. JAMA. 2022;328(2):148–150. doi:10.1001/jama.2022.10281
Related heart failure content:
In-hospital mortality more common among COVID-19 patients with heart failure
Why some heart attack patients are at a greater risk of post-discharge heart failure
Burned-out physicians twice as likely to compromise patient safety