How safe is your hospital?
A silent yet deadly healthcare epidemic is raging through America.
Infections, surgical mistakes, and other forms of medical harm are causing the deaths of up to 180,000 hospital patients every year, according to a 2010 report from the Department of Health and Human Services. An additional 1.4 million more patients are being seriously harmed by their hospital care.
Scarily, these figures apply only to Medicare patients. What happens to other patients is unclear because hospitals report only a fraction of things that can go wrong - not only that, most hospital errors go unreported.
Simply put, most hospitals simply don’t give safety the attention it deserves. Medical harm is one of the three leading causes of death in the U.S., but the government doesn’t track it as carefully as it does deaths from automobiles, plane crashes, and cancer.
There is some good news, however. Some hospitals have voluntarily taken up safety initiatives to help prevent the incidence of drug errors and infections. For instance, the rates of central-line bloodstream infections have gone down by 32 percent since 2008.
And now, Consumer Reports has given their rating of over 1,100 hospitals in 44 states for safety using the most current data available, including information from government and independent sources. They also interviewed patients, physicians, hospital administrators, and safety experts; reviewed medical literature; and looked at hospital inspections and investigations.
Their safety ratings include only 18 percent of U.S. hospitals because data on patient harm isn’t reported fully or consistently nationwide, underscoring the need for more public reporting. Even so, their ratings provide an informative assessment of the state of hospital safety nationwide.
While preparing their report, Consumer Reports focused on multiple categories including infections, readmissions, communication and CT scanning, among others.
Roughly one in 20 hospitalized patients will develop an infection, which is preventable but can easily turn deadly. Dirty instruments, improperly sterilized catheters or needles, and the contaminated hands of doctors, nurses, or other healthcare workers are common causes.
Consumer Reports rated hospitals on infections that developed after surgery or caused by central-line catheters in intensive-care units, or both. Nearly 300,000 surgical site infections occur each year in U.S. hospitals, while infections linked to central line catheters kill over 15,000 patients a year.
Yet in one promising study, 60 percent of hospitals that used an infection prevention checklist eliminated all central line catheter infections in their intensive care units for at least a year.
When a patient has to go back to hospital soon after being discharged, it can sometimes be a sign that something went wrong during the initial stay. And the more often a patient is readmitted, the greater the chance something else will go wrong. Research suggests that up to three-quarters of readmissions may be preventable.
The readmissions rating issued by Consumer Reports is based on data that tracked patients hospitalized for heart attack, heart failure, and pneumonia and who were readmitted to a hospital within 30 days of being discharged.
Lack of clear communications in hospitals is a serious problem because drug errors are commonplace and sometimes serious - while poor discharge planning can lead to readmissions. Consumer Reports awarded scores to hospitals on this criterion based on questions answered by millions of discharged patients in a federally mandated survey.
While CT scans provide essential diagnostic information, they pose risks as well. Radiation from CT scans, equivalent to between 100-500 chest X-rays, are likely to contribute to an estimated 29,000 future cancers a year, according to a 2009 study.
Consumer Reports safety ratings reported the percentage of chest and abdominal CT scans that had been ordered twice for the same patient. Referring doctors often assume that double scans provide more useful information than single scans - which is not always true.
In other words, hospital safety needs reform.
The U.S. federal government has recently given $218 million to 26 hospital groups nationwide to improve hospital safety and provided up to $500 million for programs to help Medicare patients transition safely from being in hospital to going home.
Yet some believe more needs to be done. For example, Medicare withholds payments for procedures that harm patients, but hospitals should also have to pay for the follow-up tests and treatments that those errors lead to.
The Consumers Union believes that a there should be a national system to track and publicly report medical errors. Also, hospital administrators and regulators need to listen more carefully to the people most affected by medical harm: patients. Regulators too should rigorously investigate patient complaints and use them to identify hospitals with patterns of problems. Changes in the courtroom such as relaxing gag orders and secret settlements that often prevent harmed patients from telling their stories could also help a great deal.
As a practicing physician says: “I know we are not perfect. But we need to listen to our patients and, when mistakes happen, own up so we can fix them, or at least keep them from happening again.”