Study of medical errors puts tentative price tag on impact

Hospital charges alone boosted $9.3 billion a year

October 08, 2003|By Julie Bell | Julie Bell,SUN STAFF

A handful of common medical complications kill more than 32,500 U.S. hospital patients every year and add $9.3 billion annually to hospital charges, estimates one of the first studies to put a price tag on unexpected harm to patients.

The study, which appears in this week's Journal of the American Medical Association, estimates that the same 18 categories of injury -- ranging from postoperative sepsis to surgical tools left in patients' bodies -- force people to extend hospital stays by a combined 2.4 million days a year.

Although the findings are consistent with a well-publicized 1999 report that blames medical errors for up to 98,000 deaths a year in U.S. hospitals, the new study's authors caution against accepting its conclusions as precise measurements.

The reason: Patient safety research is in its infancy, and doctors are still struggling to find accurate ways to identify, count and stop preventable injuries.

Even with the sophisticated computer methodology it used to analyze 7.45 million discharge abstracts from hospitals in 28 states, the study's results are imperfect, the authors said.

But co-author Dr. Chunliu Zhan of the federal Agency for Healthcare Research and Quality said it is the first time costs have been attributed to specific kinds of medical injuries, giving lawmakers and hospital administrators data to justify spending on patient safety.

Co-author Dr. Marlene R. Miller, of the Johns Hopkins Children's Center, said that when she gives seminars on improving patient safety, participants ask her, "What's the business case behind it?"

Now, she said, hospitals can see that reducing medical injuries is not only the right thing to do, but also makes financial sense.

"These sorts of money findings motivate people," she said. "It also helps hospitals see what kind of return on investment they'll get" from implementing initiatives that range from encouraging hand-washing to buying multimillion-dollar computer systems to track patients and prescriptions.

Dr. Gerald B. Hickson, director of Vanderbilt University's Center for Patient & Professional Advocacy, agreed. "Data like this is important at times for policy-makers to get a sense for why additional work needs to be done in this area," he said.

In addition to providing an overview of the damage done by medical injuries, the study also compared the costs of different injuries -- in length of stay, excess charges and mortality.

Worst off were patients who contracted sepsis after an operation. They were nearly 22 percent more likely to die than similar patients admitted at the same hospital.

Patients who contracted sepsis also ran up an average of $57,727 more in medical charges and stayed in the hospital about 11 days longer than similar patients who did not develop the bloodstream infection.

The authors compared patients of the same gender and race and similar ages.

At the other end of the scale, babies injured during delivery generally didn't have longer stays or higher mortality than uninjured infants. Even so, Miller hastened to say, the study doesn't capture the emotional toll on infants and families or the increased costs of follow-up visits.

Unlike some previous studies, which relied on the time-consuming process of pulling patients' medical charts, the latest study relied on the diagnostic codes hospitals use for billing and administrative purposes.

The codes are entered by hospital clerks and summarize the primary and underlying diagnoses of each patient. Medicare pays hospitals based on groups of such codes.

The authors studied 18 codes that previous research had found were often related to medical injuries. They included obvious medical mistakes, such as accidental punctures, as well as complications such as sepsis, which are only sometimes attributable to problems with medical care (for example, failing to administer the proper antibiotic).

To ensure the study's results reflected unexpected injuries, the authors left out cases in which patients had an underlying illness that itself was likely to lead to complications or death.

For example, their algorithms included patients who developed sepsis after elective surgery, but excluded those who suffered trauma before arriving at the hospital. Trauma often causes contaminated wounds, resulting in infection.

Still, both the authors and other patient safety experts doubt that codes used for billing and administrative purposes can be used to analyze medical injuries with precision.

For example, Miller said, the clerks entering codes might not include information showing that patients who got an infection had an underlying diagnosis of HIV -- which might predispose them.

Dr. Robert M. Wachter, chief of the medical service at the University of California, San Francisco Medical Center and author of a coming book about medical errors, said the authors were "appropriately circumspect" about their results.

Still, he said, "I think they did a very good job from the standpoint of statistical analysis to adjust for other factors, to the point I think it is believable that the numbers they came up with do represent additional burden from medical injuries."

In an accompanying JAMA editorial, Dr. Saul N. Weingart and Dr. Lisa I. Iezzoni, both of Harvard Medical School, raised cautions about the use of the data for studying patient injuries. But flawed as they are, the editorial suggested, the codes are a useful tool to start assessing the problem.

"Like the man searching for his lost keys under the lamppost," the editorial said, "clinicians and quality improvement professionals might reasonably start looking for potential answers where the light is best."

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