Patient Safety Requires Vigilance

Carolyn Pare, CEO of Buyers Health Care Action Group, in her blog, has posted commentary regarding a recent CDC study on same-day surgery centers. The study shows patient safety is often compromised. Read more here: http://bhcag.blogspot.com/ .

Engaging consumers is critical to improving patient safety in U.S.

Medical errors are a continuing problem, according to a May 27, 2010 Richmond Times article about the annual Virginia for the tenth annual Virginians Improving Patient Care and Safety conference. Sorrel King, the keynote speaker, challenged and inspired the audience. She said that we’ve been talking about improving patient safety for ten years and it is time we started making it happen.

The patient safety movement was launched a decade ago with release of the Institute of Medicine report—To Err is Human—that documented nearly 100,000 patients die each year from preventable medical mistakes. Today, 100,000 patients continue die each year from preventable medical mistakes and another 100,000 die from preventable healthcare associated infections. Excess healthcare costs for these infections alone totals between $28 and $45 billion.

The Leapfrog Group is a national organization that was founded by leaders of Fortune 500 companies in response to their concerns about findings in the To Err is Human report. Each year, Leapfrog surveys U.S. hospitals and public reports their progress toward safe care. In 2009, the survey was voluntarily completed by 1,244 hospitals. This represents half of the targeted hospitals, according to Leah Binder, CEO of the organization and one of the conference speakers.

Research has shown that a patient’s risk of dying is reduced by two to four times, if care is obtained in a hospital that completes the survey and meets Leapfrog standards. If non-rural U.S. hospitals used the first three patient safety practices espoused by Leapfrog, 57,000 lives and $12 billion could be saved each year.

Binder used the fact that, as of 2009, only 59% of Leapfrog reporting hospitals even have hand hygiene policies to prevent the spread of healthcare-associated infections in place to convey urgency about improving patient safety to the conference attendees. She said that 100% of hospitals should have hand hygiene policies to reduce the spread of infection.

Proper hand hygiene is universally accepted as the single most effective method for preventing the spread of dangerous healthcare infections that harm and kill hundreds of thousands of patients every year. Yet, doctors and nurses in leading hospitals wash their hands less than 50 percent of the times required with rates varying from 30 to 70 percent.

A 2010 study published in Infection Control and Hospital Epidemiology used published data and transmission rates for MRSA (a healthcare-associated infection) from a Duke hospital to calculate the cost of hand hygiene non-compliance. Accordingly, a 200‐bed hospital incurs $1,779,283 in annual MRSA infection–related expenses attributable to hand hygiene noncompliance. Every 1% increase in compliance saves an average 200-bed hospital almost $39,650 in annual savings.

Last year, leaders of national safety, quality, and purchasing organizations published a consensus stating that zero healthcare-associated infections is the only appropriate goal for U.S. hospitals. The reason for their “chasing zero” consensus is that these infections are preventable.

As much as anyone, Sorrel King knows that engaging consumers is critical to improving patient safety. Her 19-month-old daughter, Josie, died due to a preventable medical mistake. Worse still, Josie’s mother reported her concerns about changes in Josie’s behavior to the staff. If the staff had been more accustomed to viewing patients and their family members as part of the healthcare team or if King had been better equipped to speak up for safety, Josie would be alive today.

King told the audience that was emotionally unprepared to accept money in exchange for her daughter’s life. Instead, she used the settlement money to create the Josie King Foundation. Through the foundation (www.josieking.org), King has developed safety education tools for patients. She told the audience that one of their tools will be available in a few weeks as an iPhone application.

Martin Hatlie, J.D., President of Patients for Patient Safety and co-founder of Consumers Advancing Patient Safety encouraged professionals attending the conference to partner with healthcare consumers to develop effective patient safety strategies. In reality, a patient or their lay caregiver will often be the only person around to remind a busy doctors and nurses to wash their hands or perform other basic safety practices.

Just giving patients hand outs telling them to speak up for safety is not enough. We need to recognize that patient safety is a major public health issue. It will require us to use all the methods public health has available to tackle our epidemic of preventable medical mistakes and healthcare-associated infections.

With potentially lethal healthcare-associated infections beginning to spread into outpatient clinics and community settings, there may be no other patient safety topic that requires more urgent attention than proper hand washing. However, “chasing zero” is a realistic goal only if healthcare learns to engage consumers in the process.

The first order of business is increasing public awareness about the patient safety crisis. This requires more than preaching to state choirs of dedicated health professionals. Consumers in every community must come to understand the nature of the crisis and their role in improving safe care.

Gretchen B. LeFever, Ph.D., is a psychologist and senior partner with Safety and Learning Solutions, www.yoursls.com.

GOAL: Get Employers Involved Actively in Improving Quality

Employers and other purchasers of group health benefits are scrambling to comply with the provisions in the new health insurance reform bill signed by President Obama in March, the Patient Protection and Affordable Care Act. Actuaries are working overtime to figure out exactly the costs of the bill, but most employers I talk to are bracing for 5-10% increase in employee premiums by September, plus significant upfront costs reevaluating and revising benefits packages and restructuring benefits programs to adhere to with new mandates.

These compliance costs are only the beginning. The health reform bill qualifies 16 million more Americans for Medicaid, which is the program for low-income families, which traditionally pays providers only a fraction of the cost of care. The bill also counts on reductions to Medicare reimbursement to meet its budget targets. With less coming from Medicare and Medicaid, hospitals will need to find some money somewhere, and they will likely shift the perceived shortfall onto private payors. The result is not insignificant: the average premium for a family of four is already $1788 higher because of this cost shifting.

Still, despite the perils ahead, many purchasers are optimistic about the prospect of reform because they see awful quality problems every day and know how important change is. Purchasers sit in dismay each month as they read their claims reports, the dry bureaucratic language too often masking tragic medical errors and that devastate employees and their families. Purchasers have long been frustrated by the inability of the federal government to show leadership in fixing the problems. Many purchasers tried to take matters into their own hands, starting pay for performance initiatives or other incentive programs to influence providers to improve, but without the weight of federal leadership, even the largest and most active employers haven’t made the difference they would hope for.

The health reform bill includes provisions with great promise for improving quality, and many purchasers advocated for them. For instance, the bill calls for future pilot programs to test ways to organize care more efficiently, and better reward chronic disease prevention and primary care. There is a program to improve how we measure outcomes of care, so in the future we can identify which providers achieve the best results for patients. The bill has some good language holding health insurance plans accountable for performance and cost-effectiveness, and great language around wellness including permitting employer incentives and a long overdue strategic national approach to improving wellness.

Unfortunately, there is a long timing gap between when purchasers pay the bill’s costs (now) and when employees enjoy the bill’s benefits to quality (five to ten years or more from now).

This timing gap between costs and quality is a donut hole that must be filled. Upwards of 100,000 Americans a year continue to die from preventable medical errors: that’s like a jumbo jet crashing every other day and killing all on board. We would not wait five or ten years to crack down on the airline industry if that was happening. According to tracking by Leapfrog, there remain a litany of major problems in hospital quality, including some high mortality rates, persistence of medical errors, documented wasteful spending, and troubling complication rates and infections. Some hospitals perform four, five, or even ten times better than a hospital down the road for the same quality indicator.

Two things need to happen to fill in the donut hole and assure that health reform truly improves the health care all Americans recieve. First we need to encourage Congress to revisit the legislation to accelerate the quality and cost-effectiveness measures in the bill, and add a few more. For instance, purchasers have long advocated increased transparency of health information by provider, so consumers can better compare performance among different doctors and hospitals. That tends to be unpopular with some lobbyists, but it is essential for engaging the public in seeking out the highest quality providers, and crucial in motivating those providers to accelerate their quality improvement efforts.

Second, no matter what happens in Washington, purchasers must step up their demands for improved quality for their employees, and use their purchasing dollars wisely to incentivize change. With the momentum of reform, purchasers have the wind on their back and their leadership could have immediate benefit. Good models exist, and employers should turn to them for next steps in improving quality. Many health plans have pay for performance programs that would benefit from employers’ pushing for their implementation, and other good models are out there: The Premier Demonstration Project, Bridges to Excellence, Institute for Healthcare Improvement, and some Leapfrog initiatives are among those that have showed great progress in improving employee health and well-being—and controlling wasteful costs at the same time.

Policymakers are the first to acknowledge that the reform legislation is built on the very foundation of our nation’s employer-based health coverage—and without that foundation Congress would have to start over. As the core of that foundation, employers have a right and a responsibility to insist that reform address the needed improvements in quality that their employees deserve—and do so now, not later.

Leah Binder,

CEO, The Leapfrog Group