The study found that nearly 1 in 4 hospitalized patients in the United States experience an adverse event
According to a study published Wednesday in New England Journal of Medicine.
The stark findings confirm that despite decades of effort, hospitals in the United States still have a long way to go Patient safetyexperts say.
“These numbers are disappointing, but not shocking,” said Dr. David Bates, chief of general medicine at Brigham and Women’s Hospital in Boston, who led the study. “They showed we still have a lot of work to do.”
The research looked at the medical records of 2,809 patients who were hospitalized at 11 Boston-area hospitals in 2018. The study excluded people who were admitted only for observation, reproduction, rehabilitation, addiction treatment or psychiatric care.
Hospital data showed that 663 of these patients – about 24% – experienced at least one event during their stay that negatively affected their health, even temporarily.
A total of 222 adverse events were considered preventable, which means that The error led to harm to the patient. This translates to about 7% of the total admissions analyzed by the researchers. Twenty-nine subjects, or 1% of all those admitted, had serious, preventable adverse events resulting in significant harm. One death was considered preventable.
However, the majority of poor outcomes were considered not preventable. This can include Known side effects from some medicationsknown risks associated with surgery.
The most common adverse events overall (approximately 40%) were related to medication given in hospital. Surgery and other procedures accounted for just over 30%, followed by what the study authors call “patient care events” at 15%. These include falls and bedsores, both of which are considered preventable.
One bright spot, experts said, is that Infections acquired in the hospital It accounted for only about 12% of adverse events – a significant decrease from the 1991 study which found infection was the second most common adverse event.
That 1991 study, called Harvard Medical Practice Study 1It is considered an outstanding research. It used data from patients hospitalized in New York state in 1984, and found that only about 4% of patients in the hospital experienced harm. However, the study looked for a smaller range of adverse events than the current research, and hospitals are much better at reporting harm when it occurs.
“It’s clear, at least, that the rate hasn’t gone down and that damage is still a really serious problem,” Bates said.
While progress has been made in some areas, new risks have emerged as medicine advances, said Dr. Albert Wu, director of the Center for Health Services and Research Outcomes at Johns Hopkins Bloomberg School of Public Health, in an email.
“Although we have removed some of the causes of harm, new types of damage have emerged, associated with effective new drugs and new procedures,” said Wu, who was not involved in the new research.
For example, drug companies have made great progress over the three decades since the last report was published, but with the plethora of drugs available comes a greater opportunity for drug-related errors.
“There are many more drugs available today than there were in 1991, and some drugs have a smaller therapeutic margin, which is the gap between a therapeutic effect and a dangerous dose,” said Dr. Donald Berwick, honorary chair and senior fellow at the institute. To improve health care in Boston. Berwick Books editorial which were published Wednesday along with the new study.
Even technologies implemented to prevent medication errors can create new opportunities for accidents.
New technologies are always double-edged and need intense monitoring to keep an eye on them. “You have to anticipate what could go wrong and build barriers around the risks,” Berwick said.
That is at the heart of The issue of patient safety is staffing.
“Since we have done research on patient safety, we have consistently found that one of the main explanations for poor patient outcomes is an insufficient number of nurses at the bedside,” she said. “Having an adequate number of nurses is an essential building block for safety.”
in 2018 study Published in the Journal of Health Affairs, Aiken and her team interviewed nurses in 535 hospitals in the United States, sixty percent of whom reported that there were not enough nurses in their hospitals to provide safe patient care. The pandemic has already stressed the nursing staff, which has led to strikes.
Only one state, California, has legal standards regarding the minimum number of staff needed for safety in a hospital. One nurse cannot take care of more than five patients at the same time.
“If you really implement a standard like this, you can save a lot of lives that fall under patient safety,” Aiken said. They can be prevented, but there are very few nurses out there to provide the kind of care that would prevent those adverse events from happening.”
Experts said efforts must also be made to prevent damages that are classified as non-preventable as well.
“Practices are evolving so that unavoidable errors can be prevented through changes in practice,” Wu said. “For example, if you completely stop using a medication, that is [has a] The higher the rate of adverse effects that are not preventable, these adverse effects will no longer occur.”
Dr. Peter Pronovost, chief quality officer and clinical transformation at University Hospitals in Cleveland, used to work on preventing bloodstream infections, which were once considered “inevitable rather than preventable.”
“When we changed that narrative, and used checklists, we reduced these infections that were killing more people than breast or prostate cancer by 80 percent,” he wrote in an email.
Wu said patients should “keep in mind that there is a potential for harm during their hospitalization.” He encouraged patients to strive to be an active part of their healthcare team, telling hospital staff about their diagnoses, medications they’re taking, allergies they have, and care they’re receiving elsewhere.
“If you think something might be wrong, speak up!” He said.
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