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Hospital stays caused damage to 1 in 4 Medicare patients

One in four Americans covered by Medicare suffered some form of temporary or lasting damage during hospital stays before the COVID-19 pandemic, government researchers said in a surveillance report released Thursday .

A report from the U.S. Department of Health and Human Services’ Office of the Inspector General said 12% of patients had “adverse events” that resulted in primarily longer hospital stays, but also permanent, fatal damage. or required a life-saving intervention. Another 13% had temporary problems that could have caused more complications if hospital staff had not acted.

Researchers reviewed the medical records of 770 Medicare patients discharged from 629 hospitals in 2018 to formulate a national rate on how often patients were harmed, whether preventable or not. A previous review by the Inspector General published in 2010 found that 27% of patients suffered some form of damage, a survey that led to new efforts and incentives for patient safety.

The incremental improvement follows an intense focus on patient safety since at least 1999, when the then Institute of Medicine published To Err is Human, a historical report that estimated that up to 98,000 deaths a year could be due to medical errors. Since then, initiatives have sought to improve patient safety by limiting medical errors, reducing drug confusion, and making hospitals with a poor patient safety record responsible through the Medicare program to derail the worst-paying paychecks. a list of security measures.

Although Inspector General’s investigators observed improvements in certain security measures, officials said the 25% damage rate is worrying and deserves renewed attention from hospitals and two federal agencies overseeing security. of patients: the Medicare and Medicaid Service Centers and the Agency for Health Research and Quality. .

“We still have a long way to go in terms of improving patient safety,” said Amy Ashcraft, deputy regional inspector general.

Among the Inspector General’s recommendations: Expand the types of complications assessed according to the Medicare performance payment program.

A pay-as-you-go program, created by the Affordable Care Act, cuts 1% of Medicare pay for lower-ranking hospitals for complications such as infections, hip fractures, blood clots, bleeding, or sepsis.

But of the examples of damage discovered by the inspector general, only 5% would be complications that are now assessed under the Medicare performance pay program. In other words, hospitals do not face reduced payments for the vast majority of complications.

The report found that a lower percentage of injury cases would be marked under another Medicare program, created by the Deficit Reduction Act of 2005, which seeks to limit additional payments for complications that are likely to be prevented.

The report found that the most common types of damage include side effects from medication; other common problems include ulcers, surgical complications, and infections.

Nashville nurse’s conviction shocks security

Other studies suggested that the nation’s health care system made great strides in preventing or reducing infections before COVID-19 stressed hospitals, nursing homes, and other health centers.

“Central line” catheter infections inserted into patients’ veins dropped 31 percent in U.S. hospitals five years before the pandemic. But these infections increased by 28% from April to June 2020, the frantic period in which COVID-19 began to spread rapidly, according to a February article in the New England Journal of Medicine.

COVID-19 emphasized U.S. hospitals as the ranks of doctors, nurses, and other caregivers spread, said Dr. Michael Ramsey, executive director of the Patient Safety Movement Foundation, a nonprofit organization. based in Irvine, California.

But Ramsey believes hospitals are ready to make up for lost security gains during COVID-19. He cited Medicare’s 1% pay cuts for poor results as a motivating factor for hospitals to improve.

“It has to come from the top down,” Ramsey said. “You have to have the board’s bonuses based on hospital safety, down to the lowest person.”

Hospitals also need to emphasize routines to prevent infections, such as doctors and nurses washing their hands and checking patients’ names before administering medications, he said. Hospital workers should feel comfortable talking when they notice problems.

RaDonda Vaught is a former ICU nurse in Nashville, Tennessee, who was found guilty in March of homicide for criminal negligence after giving the wrong medication to a patient at Vanderbilt University Medical Center who died. She is scheduled to be convicted on Friday.

From the first moment, Vaught admitted the mistake. In a recent interview, he told The Tennessean that he “does not regret telling the truth.”

Nurses across the country are seeing the outcome of the case, and Ramsey believes it has the potential to have a chilling effect on workers who would otherwise talk about the safety issues of the patients they observe.

“It’s going to put things back on you because people won’t talk as easily as she said,” Ramsey said.

It is also important for patients and their families to feel comfortable raising concerns and asking nurses and doctors questions, said Melissa Mullamphy, a blogger from Holmes, New York, who published a book detailing her efforts to navigate the system. doctor during his mother’s battle with cancer.

He urges patients and their families to ask about medications, staffing levels, and treatment plans, and recommends that they investigate hospital patient safety levels on public websites such as CMS Hospital Compare or private websites.

“There are ways to protect your loved ones,” Mullamphy said. “You have to be assertive, and you have to ask the hard questions.”

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