Hospital-acquired conditions decline, but major problems still exist for providers

Hospital-acquired conditions have declined by 17 percent between 2010 and 2013, from a rate of from 145 HACs per 1,000 discharges to 121, according to a new report by the Department of Health and Human Services.

The long-standing problem of hospital-acquired infections, adverse events and medication errors is improving, new data suggest, although 1 in 25 hospital stays still comes with an infection.

Hospital-acquired conditions have declined by 17 percent between 2010 and 2013, from a rate of from 145 HACs per 1,000 discharges to 121, according to a new report by the Department of Health and Human Services. Based on patient medical records, CDC surgical data and other survey data, the study estimates that the reductions have translated into 1.3 million fewer hospital-acquired conditions, 50,000 fewer patients deaths and $12 billion in savings over the three-year period.

"No American should ever lose his or her life, or spend the holidays in the hospital because of a condition that could have been prevented," said HHS Secretary Sylvia Mathews Burwell, in a speech at the Centers for Medicare & Medicaid Services Quality Conference on Tuesday. The new data, she said, “suggests we could be at an important moment when it comes to the way we deliver healthcare in this country. But to get there, we need to make an even bigger push.”

Much of the progress came in 2013, when about 35,000 fewer patients died in hospitals compared to the previous years. In 2013, the study found, there were 800,0000 fewer HACs that would have cost around $8 billion.

As part of the Partnership for Prevention program with hospitals, the HHS Agency for Healthcare Research and Quality has been conducting the study since a first setting a baseline estimate in 2010, tracking 27 different measures, including adverse drug events, catheter-associated urinary tract infections, central line-associated bloodstream infections, antibiotic-resistant Clostridium difficile, Methicillin-resistant Staphylococcus aureus, pressure ulcers, and post-operative venous thromboembolisms and hemorrhages.  

The problem of hospital-acquired conditions and errors have been plaguing the American health system for decades, and really entered the public consciousness in 1999, with the Institute of Medicine’s “To Err is Human” study estimating that as 98,000 Americans were dying from errors, infections and harm in hospitals.

Subsequent studies have pegged the number of deaths related to HACs even higher — 180,000 in the Medicare population alone, according to a 2010 HHS Inspector General study, and as many as 440,000, according to a 2013  Journal of Patient Safety study, which would make healthcare errors the third-leading cause of death in the country.

Chart: Five HACs with greatest percent declines

The latest federal data still leave a fair amount of uncertainty — because “there is not consistent data from before 2010 that can be used for comparison,” as AHRQ said.

Whatever the actual rate of HACs, federal health officials, hospital leaders and patient advocates would probably agree it’s too high.

From C.diff. to sepsis, HACs are now a problem many patients are actively concerned about, from word-of-mouth tales, social media and consumer-oriented studies of public-reporting on individual hospital performance. Infections, in particular, have come to the fore in recent years, as several dangerous antibiotic-resistant strains of pathogens have evolved globally. “On any given day, about 1 in 25 hospital patients has at least one healthcare-associated infection,” the CDC warns, based on data from 2011, when the agency estimates that there were 722,000 hospital-acquired infections that led to the deaths of 75,000 patients.

American hospitals have been making progress in safety, CMS and AHRQ emphasized, with many of the most common HACs falling between 2010 and 2013, mostly from declines in adverse drug events and prevention of pressure ulcers.

Adverse drug events declined by 19 percent, catheter-associated urinary infections 28 percent, central line-associated bloodstream infections 49 percent, pressure ulcers 20 percent, surgical site infections 19 percent, and postoperative thromboembolism 18 percent.

Not every area of measure improved. The rate of two HACs increased slightly between 2010 and 2013. The rate of kidney injuries associated with contrast dyes in catheter angiography increased 10 percent, from 6.9 per 1,000 discharges to 7.6 per 1,000, and antibiotic-resistant C. difficile increased about 16 percent, from 2.6 to 3.1 per 1,000.

But on the whole, the American healthcare seems to be getting safer, the HHS study argues. “The increase in safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events, spurred in part by Medicare payment incentives,” AHRQ officals wrote. The American Hospital Association believes commercial insurers should align with those incentives to streamline ways for hospitals to focus on quality and safety.

The healthcare industry has been paying heed to one of the original themes in the IOM’s “To Err is Human” — rethinking and redesigning systems. “Among those principles was an awareness that many threats to patient safety originate in bad systems, not bad people. Patients and their skilled providers find themselves in systems that do not always take into account the factors and challenges presented by the complexities of modern healthcare.”