A hospital is a place of healing. It can also be a place of injury. In the U.S., 2.9% of people who enter the hospital are actually harmed by the care they receive. Yet what are the costs of these injuries?
A paper by Encinosa and Hellinger (HSR 2008) attempts to estimate the cost of hospitals failing to prevent advser medical outcomes. The authors examine 14 patients safety indicators (PSIs) such as: anesthesia complication, accidental laceration, foreign body left in, iatrogenic pneumothorax, transfusion reaction, infections due to medical care, sepsis, pulmonary embolism and deep vein thrombosis, acute respiratory failure, physiologic and metabolic derangements, hemorrhage/hematoma, wound dehiscence, postoperative hip fracture and decubitus ulcer.
The authors found the following results:
“Excess 90-day expenditures likely attributable to PSIs ranged from $646 for technical problems (accidental laceration, pneumothorax, etc.) to $28,218 for acute respiratory failure, with up to 20 percent of these costs incurred postdischarge. With a third of all 90-day deaths occurring postdischarge, the excess death rate associated with PSIs ranged from 0 to 7 percent. The excess 90-day readmission rate associated with PSIs ranged from 0 to 8 percent. Overall, 11 percent of all deaths, 2 percent of readmissions, and 2 percent of expenditures were likely due to these 14 PSIs. ”
- Encinosa WE, Hellinger FJ (2008) “The Impact of Medical errors on Ninety-Day Costs and Outcomes: An Examination of Surgical Patients” Health Services Research, v43(6): 2067-2085.
That list of “errors” has several ridiculous causes included along with the more defensible ones…
1. Transfusion reactions are not exactly due to medical error–>they can and many times are based on the unavoidable fact that when you get transfused, lymphocytes accompany the transfusion and you get a febrile reaction…
2. Infections due to medical care-> again, its all relative as if you need a Foley and a ton of different lines in you because you have sepsis/shock, odds are you will get an infection but then you are in shock and that’s the cause of you having so many lines placed in you in the first place.
3. Pulmonary embolism and deep vein thrombosis-> the authors would do well to look this up because being in a hospital is a risk factor because the people there are sick (and thus, inactive) and post surgery many times, both of which are the root causes of DVT. Hospitals gather that group under one roof and of course people who match that description seek medical care…
4. Acute respiratory failure->they would do well to explain how this is the result of medical care and not the underlying illness. Drug induced ARF is quite rare and the other causes suffer from the same weakness as above.