More hospital focus on inpatient complications needed, says report

There are more inpatient safety complications happening in hospitals that result in greater costs to patients and the healthcare system than are being monitored by the Centers for Medicare & Medicaid Services. A new analysis by Premier determined a more robust measure for identifying a wider set of potential hospital inpatient complications needs to be developed.

Premier examined 5.5 million patient discharges across 530 U.S. hospitals in 2013, and identified 86 inpatient complications associated with significant increases in mortality rates, costs and length of stay.

During a press call last week, Richard Bankowitz, chief medical officer at Premier, explained that those 86 conditions were associated with nearly 50,000 potential deaths, $4.3 billion in costs and 1.7 million added hospital days.

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In contrast to hospital-acquired conditions (HACs) eligible for penalties by CMS, the Premier analysis found many more safety events happening with greater frequency, and at a greater cost to patients and the healthcare system overall, according to Bankowitz.

For instance, eight CMS HACs occurred so infrequently that the number cases counted fewer than 50 in each. In addition, the CMS HACs accounted for 2 percent of the total potential deaths, 13 percent of the total costs and 12 percent of the total added days.

"CMS HACs are serious and important events to prevent, but providers need to focus on a wider set of higher-impact complications to avoid missing opportunities for quality and cost improvement," said Ramon Meguiar, senior vice president and chief medical officer at Memorial University Medical Center in Savannah, Ga., and a speaker during the press call. "Looking exclusively on a narrow list of measures fails to examine an important cause of unjustified variation, and broadly assess the quality of patient care in a particular institution."

In light of its findings, Premier developed a list of the 10 potential inpatient complications (PICs) that have the highest association with mortality, cost and length of stay, said Bankowitz. Those are: acute renal failure, hypotension, respiratory failure, sepsis/bacteremia, aspiration pneumonia, acute myocardial infarction, gastrointestinal ulceration and hemorrhage, cerebral infarction, pulmonary embolism and ventilator associated pneumonia.

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These 10 PICs were associated with nearly $2.5 billion in costs, 24,000 potential mortalities and 920,000 added days in the hospital across approximately 530,000 cases, according to Bankowitz.

During the press call, Sharon Powell, patient safety officer and director of performance improvement at Frederick Memorial Hospital in Frederick, Md., explained that by instituting a multi-disciplinary task force at her hospital focused on the early recognition and appropriate management for severe sepsis cases, Frederick Memorial Hospital was able to significantly bring down their sepsis mortality rate by 45 percent.

Prior to instituting the task force, Powell said her hospital was experiencing a problem with excess sepsis mortality rates – 35 to 60 excess deaths per year – but after providing additional education to staff and physicians on early recognition and treatment of sepsis, along with a nurse screening tool and implementation of a sepsis protocol for the ED, Frederick Memorial Hospital has seen complications within the sepsis population and hospital-acquired sepsis drop by 40 percent, along with the average cost per case for sepsis patients decreasing by $735 per patient.

"I think the key takeaways from this are that early detection and rapid response to deterioration is important, that changes are not going to happen overnight, and leadership involvement is key," said Powell. "It's very important to zero in on complications that could have a large, simultaneous impact on multiple measures, including reimbursement."

[See also: Premier comments on Medicare ACO program]