DN Editorial: Danger: Hospital care ahead

A study shows that many institutions lack a 'culture of safety'

TWO RECENT reports have determined that hospital stays can be hazardous to your health.

Still.

In 1999, a shocking report by the independent Institute of Medicine, which advises the government on health issues, found that medical mistakes were the cause of a million injuries and up to 98,000 deaths a year.

The report was supposed to be a turning point in the patient safety movement. In the years since, medical institutions have touted new measures to reduce hospital-acquired infections and medication errors as well as to prevent so-called "never events," the mistakes that are never supposed to happen in a health-care setting but too often do.

Yet a study of 10 hospitals in North Carolina - a state that ranks high in patient-safety policies - found that things aren't improving. In an article published last week in the New England Journal of Medicine, researchers from Harvard Medical School reported that, from 2002 to 2007, about 18 percent of patients were harmed during their hospital stays and 61 percent of the injuries were preventable. While most of the "harms" detected in the study were treatable, 2.4 percent proved fatal.

The study followed by only a few weeks a report from the inspector general of the Department of Health and Human Services that offers more appalling statistics: In one month - October 2008 - it found that one in seven Medicare beneficiaries suffered harm when they were hospitalized - and about 44 percent of the injuries were preventable. Medical mistakes contributed to the deaths of 15,000 patients that month. Multiply it out: that's 180,000 patients a year whose deaths were hastened by the hospital care that was supposed to help them. The errors cost the taxpayers $4.4 billion more in Medicare payments annually.

By comparison, 33,808 people died in traffic accidents last year. A couple of observations:

* This level of preventable injuries and deaths is hardly the record you'd expect from the "best health care in the world," as opponents of reform describe the U.S. system.

* While some medical malpractice lawsuits are probably bogus, it's clear that a lot of people are getting hurt needlessly. Maybe more than "tort reform"and caps on payouts are needed to cure the problem.

* It's not that hospitals are clueless about what works, including electronic record-keeping, limiting the number of hours that medical personnel are on duty, even frequent hand-washing. Many hospitals have made significant progress, but implementation is uneven: Only 9.1 percent of hospitals have just the most basic electronic record-keeping, for example.

The new Affordable Care Act includes a provision for fining 25 percent of the hospitals with the highest medical error ratio. While accountability is important, will the threat of financial penalties keep medical personnel from reporting their errors so others can learn from them?

The most effective approach will involve collecting much more data and developing a "culture of safety," says Dr. Gordon Schiff, the associate director of Patient Safety Research at Brigham and Women's Hospital in Boston. That requires both teamwork and focus and the understanding that "we're all in this together."

These are qualities that are harder to practice in a health-care system as complicated and expensive as it is now - and which presents what Schiff has called a "fatal distraction" from patient safety. And that makes the looming battle over whether to repeal the health-care reform law even more potentially hazardous to our health.