Medical injuries incurred by patients while in hospital result in longer hospital stays, increased hospital charges, and more than 30 000 deaths each year, a study published this week says (JAMA 2003;290: 1868-74).
The study analysed patient safety indicators—measures recording incidences related to patient safety while in hospital—from the Agency for Healthcare Research and Quality to identify medical injuries in 7.45 million hospital discharge abstracts from 994 acute hospitals across 28 states for the year 2000. This was equivalent to a 20% stratified sample of non-federal acute hospitals in the United States.
Results were assessed for the impact of medical injuries on length of hospital stay, hospital charges, and deaths attributable to medical injuries during hospitalisation, although the researchers noted that their findings were likely to represent an underestimate compared with other reporting systems for medical injuries.
Results showed that postoperative sepsis—which was recorded in 2595 patients—had the biggest impact, resulting in hospital stays of almost 11 days longer than in patients without this complication. This increased charges by $57 727 (£34 700; €49 000) per patient and the risk of death after surgery by 21.9%.
On the basis of these findings, the researchers estimated that about 3000 Americans died each year due to postoperative sepsis. The next most serious medical injury was postoperative reopening of a surgical incision, resulting in an average increase in hospital stay of 9.4 days, $40 323 in added charges, and a 9.6% increase in the risk of death. Infection due to medical care was associated with 9.58 extra days of hospital stay, $8656 in excess hospital charges, and 4.31% attributable mortality.
Carolyn Clancy, director of the Agency for Healthcare Research and Quality, said: “This study gives us the first direct evidence that medical injuries pose a real threat to the American public and increase the charges of health care. The nation's hospitals can use this information to enhance the efforts they are already taking to reduce medical errors and improve patient safety.”
One of the research group members, Chunliu Zhan, also from the agency, added: “Although medical injuries are recognised as a major hazard in the healthcare system, there has previously been little information on their impact. This study shows that some injuries incurred during hospitalisation pose a significant threat to patients and costs to society. We need more research to identify why medical injuries occur and find ways to prevent them from happening.”
In an accompanying editorial in JAMA (pp 1917-9), Saul Weingart, assistant professor of medicine, and Lisa Iezzoni, professor of medicine, both from Harvard Medical School, Boston, argued that clear measures and definitions of medical injuries were needed before the problem could be improved. They suggested that developing and validating a robust set of measurement tools was essential to “move patient safety information out of the shadows and into the light,” pointing out that these should focus on preventable injuries in order to be maximally useful.