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Safer Care for Some Hospitalized Patients

Summary and Comment |
March 13, 2014

Safer Care for Some Hospitalized Patients

  1. Daniel D. Dressler, MD, MSc, SFHM, FACP

Adverse events are declining in patients with acute myocardial infarction and congestive heart failure but not for patients with pneumonia or those requiring surgery.

  1. Daniel D. Dressler, MD, MSc, SFHM, FACP

Since 2001, patient safety efforts (supported by private and government organizations) have focused on improving care outcomes and preventing adverse events throughout the U.S. healthcare system. But are these initiatives successful? Agency for Healthcare Research and Quality investigators studied 61,523 Medicare patients hospitalized at 4372 US hospitals from 2005 to 2011 for myocardial infarction (MI), heart failure (HF), pneumonia, and conditions requiring surgery.

The incidence of hospital adverse events — including adverse drug events, hospital-acquired infections, postprocedural adverse events, and other adverse events (e.g., pressure ulcers, falls) — declined significantly from 2005 to 2011 for patients with MI (from 402 to 262 per 1000 hospitalizations) and HF (from 235 to 167 per 1000 hospitalizations) but did not decline for patients with pneumonia or with conditions requiring surgery. Among surgical patients, pressure ulcers, postoperative pneumonia, and adverse events associated with hip replacement were more common in 2011 than in 2005. Postprocedural contrast-induced nephropathy increased significantly in all four patient groups.

Comment — HOSPITAL MEDICINE

  1. Daniel D. Dressler, MD, MSc, SFHM, FACP

Systematic quality improvement initiatives likely are contributing to patient safety outcome improvements, leading to an estimated 81,000 fewer adverse events in myocardial infarction and heart failure patients in 2010 and 2011 compared with the number of events in 2005 and 2006. However, the lack of significant change in two other large patient cohorts and the fact that contrast-induced nephropathy continues to increase are disconcerting. These areas are appropriate targets for patient safety initiatives in coming years.

Comment — CARDIOLOGY

  1. Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Quality improvement efforts for myocardial infarction and heart failure have largely focused on minimizing errors of omission (e.g., ensuring the provision of evidence-based therapies). This study highlights patient safety issues. The improvements are encouraging: In patients with MI, infections and adverse drug events were significantly less common in 2011 compared with 2005, and in those with HF, rates of postprocedural events and infection have dropped. However, there is plenty of room for improvement: In the final year of this study, 19.4% of patients with AMI and 14.2% of those with heart failure experienced at least one adverse event, and the relative risks for postprocedural events in MI patients and for adverse drug events in HF patients did not change significantly between 2005 and 2011. While we focus on improving our ability to help, we should remain vigilant against doing harm.

Harlan Krumholz, MD, the Editor-in-Chief of NEJM Journal Watch Cardiology, was one of the authors of the article but had no role in writing or reviewing this summary.

  • Disclosures for Daniel D. Dressler, MD, MSc, SFHM, FACP at time of publication Editorial boards Hospital Medicine Reviews; Journal of Hospital Medicine

  • Disclosures for Frederick A. Masoudi, MD, MSPH, FACC, FAHA at time of publication Royalties Darling, Milligan, Smith & Lesch Grant / research support Agency for Healthcare Research and Quality; American College of Cardiology; Patient-Centered Outcomes Research Institute Editorial boards Circulation: Cardiovascular Quality and Outcomes Leadership positions in professional societies American College of Cardiology (Senior Medical Officer, National Cardiovascular Data Registries); American Heart Association (Vice Chair, Council on Quality of Care and Outcomes Research)

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