I suspect this figure of $260+ million is actually an underestimate because there is a lot of preventable harm that does not get counted as such. For example, we reduced our rate of ventilator associated pneumonia at BIDMC considerably over the last three years by rigorous application of the VAP bundle. Likewise at Cooley Dickinson Hospital in Northhampton, MA.
As best as I can tell, VAP is not included in the statistics above. Chances are those cases previously would not have been counted as medical errors. They were just part of the mentality of "these things happen," a belief by many that the current level of harm caused by hospitals is a statistically irreducible number.
Notice that I say "caused by hospitals," and not "occurring in hospitals." Until we take ownership of the fact that a great degree of harm that occurs in hospitals is caused by failures in the manner of delivering care, we will not make progress.
Paul, many thanks for continuing to hammer away at the issue of preventable harm. I am reminded of another of your adages - that you prefer to talk about preventable harm in terms of individual people maimed or killed rather than numbers, because numbers do not convey the agony.
ReplyDeleteHowever, I am afraid that only the numbers speak to most hospital CEO's; only if they start losing $$ over this may they be motivated to act. And how to act? You have the answer:
"Notice that I say "caused by hospitals," and not "occurring in hospitals." Until we take ownership of the fact that a great degree of harm that occurs in hospitals is caused by failures in the manner of delivering care, we will not make progress."
Keep hammering.
nonlocal MD
Is it your premise that all adverse events are "errors" by definition?
ReplyDeleteNot at all. You need to distinguish between preventable and not preventable.
ReplyDeletePaul, I am pleased that you continue to remain a passionate advocate for health care quality improvement. We need your strong voice. I included your post on my blog, which is read widely by attorneys and consumer advocates like Health Care for All and the Josie King Foundation. We need to work together to continue to get the word out.
ReplyDeletePaul,
ReplyDeleteThanks for noticing our tool! I lead Patient Safety at GE and am a long time reader, second time commenter. Thought I could clarify a couple items you asked about... As for the $260M number, it is almost certainly understated. The tool does not include ALL errors, just the top 10. Moreover, many would agree that some errors are not classified as such so there is pervasive underreporting. So the tool doesn't reflect the full scope of errors. As for VAP, the Society of Actuaries data, which the tool is based of off, does not include it as one of the top 10 medical errors.
Thanks again for leading the conversation. We share your passion about working with providers to better understand harm.
Good luck as you enter a new chapter in your life.
Best,
Jeff Terry
nextlevel.gehealthcare.com
This is an interesting article and I am happy that there is some indication of the impact of infections in the hospital environment readily available to the public (ICHE has some cost analysis articles but they are open access).
ReplyDeleteI do have to bring attention to one thing. You say: "Notice that I say "caused by hospitals," and not "occurring in hospitals."
I would ask that you think about infections that are being brought in from the community, so-called "community introduced hospital acquired infections." These bacteria, viruses, fungi and parasites are being spread as a result of poor environmental cleaning and adherence to hand hygiene.
I believe that if we had more emphasis on keeping surfaces (both inanimate and animate) low in microbial burden then there might be a greater sense of prevention and a reduction in levels of infection.
I also have a 'zone theory' with respect to this idea of infection control that I could get into in-depth if you (or anyone) are interested. It has gained some popularity with companies and I hope will garner more interest as we move forward in 2011.
Looking forward to your comments.
@JATetro
Somethings like infections just simply cannot be helped. Such a shame we live in a world where we cannot cope with things "just happening". There always has to be someone to blame and someone to sue.
ReplyDeleteeye on the ward