Becker's Clinical Quality & Infection Control

14 QUALITY IMPROVEMENT & MEASUREMENT Preventable Medical Errors Are on the Decline — 4 Possible Reasons Why By Shannon Barnet A n opinion piece published in JAMA in June suggests hospi- tals have been making significant progress in reducing harm over the last few years and highlights factors contributing to the progress. e lead author of the viewpoint is Rich- ard Kronick, PhD, a health policy expert with UC San Diego. Two officials from the Agency for Healthcare Research and Quality — Deputy Director Sharon Arnold, PhD, and Director of the Center for Quality Im- provement and Patient Safety Jeffrey Brady, MD — co-authored the piece. e analysis was based on data from the AHRQ/CDC's Medicare Patient Safety Mon- itoring System, the "only source of reliable nationwide estimates on a broad range of patient harms," according the authors. e data show the adverse events rate for all hospitalized adults fell from 145 adverse events per 1,000 hospitalizations in 2010 to 121 events per 1,000 hospitalizations in 2014 — a decrease of roughly 4.5 percent each year. Additionally, analysis of the data suggests there were 2.1 million fewer adverse events between 2010 and 2014 than would have occurred if the adverse event rate had remained at the 2010 rate. e decline in pa- tient harm was associated with an estimated tens of thousands fewer deaths and billions of dollars in cost savings by the authors. Drs. Kronick, Arnold and Brady outlined the following four potential factors behind the decline in adverse events. 1. Progress stemmed from the existence of previous evidence about how to improve safety. 2. Tools and technical assistance enabled hospitals to implement evidence-based protocols to improve safety. 3. Hospitals used data and measures to assess their patient safety culture and track progress in their adverse events rates. 4. Hospital leaders were committed to success and took steps to get involved in the process. "Despite the progress made to date, much work remains to be done," the authors wrote. "e most important question moving forward is how to maintain, or if possible accelerate, the annual decline in adverse events." n Most Readmissions Aren't Linked to Suboptimal Care, Study Finds By Heather Punke A large number of 30-day readmissions are not caused by poor-quality care, but are instead relat- ed to mental health, substance abuse or homeless- ness, according to a study published in JAMA Surgery. Researchers in Seattle examined one year's worth of read- missions data from a Level I trauma center and safety-net hospital. Among 2,100 discharges, 173 patients were readmitted to the hospital. Almost one-third of those readmissions fell into two groups: injection drug users who were readmitted for infections at new sites (29 patients, or 17 percent of re- admissions) and people with lack of adequate social sup- port, leading to issues around discharge and follow-up process (25 patients, or 14.5 percent of readmissions). Other causes of readmission were: • Infections not detectable during index readmission (23 patients, 13 percent) • Illness related to injury or condition (16 patients, 9 percent) • Preventable complication of care (16 patients, 9 percent) • Deterioration of medical conditions (two patients, 1 percent) "Many cases of readmissions may truly be unavoidable in current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the study authors wrote. "A large num- ber of readmissions were not owing to suboptimal medi- cal care delivered at the index admission…but many were owing to confounding issues of mental health, substance abuse or homelessness, issues that require more intense in-hospital and postdischarge social support than most hospitals…can currently provide." This isn't the first study that has called the usefulness of using readmissions as a quality metric into question. For instance, research published last fall in JAMA Internal Medicine noted that penalties in the Hospital Readmis- sion Reduction Program unfairly punish hospitals that provide care for more vulnerable patients. "Perhaps with yet another article questioning the role of 30-day readmissions, we should focus our attention on finding better markers of surgical quality," two physicians wrote in invited commentary in JAMA Surgery. n

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