One in four hospitalized Medicare patients experienced harm during a one-month period in 2018, according to a new government report.
The HHS Office of Inspector General reviewed medical records for a random sample of 770 Medicare patients who were discharged from acute care hospitals during October 2018. The report authors conducted a two-stage medical record review to estimate a national incidence rate of adverse events (defined as events that led to longer hospital stays, permanent harm, life-saving intervention, or death) and temporary harm events (defined as events that required intervention but did not cause lasting harm, prolong hospital stays, or require life-sustaining measures). They calculated potential costs incurred by Medicare as a result of these events, determined whether the events were on the CMS lists of hospital-acquired conditions, and compared the results to the office's 2010 report. Results were published May 9.
Overall, 25% of Medicare patients experienced adverse events or temporary harm events during their hospital stays in October 2018. Twelve percent experienced adverse events, while 13% experienced temporary harm events. The most common type of harm event was medication-related (43%), such as delirium or other changes in mental status. The remaining events pertained to patient care (23%), such as pressure injuries; to procedures and surgeries (22%), such as intraoperative hypotension; and to infections (11%), such as hospital-acquired respiratory infections. Physician-reviewers determined that 43% of harm events could have been prevented if patients had received better care, including seven of the 11 adverse events that contributed to or resulted in death. Of the identified harm events, 5% were on the CMS Hospital-Acquired Condition Reduction Program list and 2% were on the CMS Deficit Reduction Act Hospital-Acquired Condition list. About 23% of Medicare patients who experienced harm events required treatment that led to additional Medicare costs, which investigators estimated to be in the hundreds of millions of dollars for the month-long study period. In the 2010 report, the office had found that 27% of hospitalized Medicare patients experienced harm in October 2008.
The preventability of certain adverse events may be overstated based on the retrospective nature of medical review, the report authors noted. They added that the prevalence of comorbidities is rising in the Medicare population, potentially affecting the prevalence and preventability of adverse events, among other limitations.
“Given our findings, HHS leadership and agencies must work with urgency to address these persistent harm rates and promote patient safety in hospitals,” the authors wrote.