Injuries in hospitals pose threat to patients

Longer LOS, higher number of deaths seen

Medical injuries during hospitalization resulted in longer hospital stays, higher costs, and a higher number of deaths in 2000, according to a study from the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD. The study, Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization, was published in the Oct. 8, 2003, Journal of the American Medical Association.

Chunliu Zhan, MD, PhD, researcher for AHRQ and the co-investigators found, however, that the impact of medical injuries varies substantially. Postoperative bloodstream infections (BSIs) had the most serious consequences, resulting in hospital stays of almost 11 days longer than normal, added costs of $57,727, and an increased risk of death after surgery of 21.9%.

3,000 deaths per year from post-op BSIs

Based on those data, researchers estimate that 3,000 Americans die each year from postoperative BSIs.

The next most serious event was postoperative reopening of a surgical incision, with 9.4 excess days, $40,323 in added costs, and a 9.6% increase in the risk of death. This equates to an estimated 405 deaths from reopening of surgical incisions annually.

Birth and obstetric trauma, in contrast, resulted in little or no excess length of stay, cost, or increase in the risk of death.

"The media seems to be talking more about the total numbers," notes Zhan, conceding that they are certainly eye-catching. "If you put the 18 types [of injuries studied] together, you will find that at least 32,000 Americans die each year in hospitals due to injuries. They also account for a total of 2.4 million extra days in the hospital and $93 billion."

The study used AHRQ’s Patient Safety Indicators and Healthcare Cost and Utilization Project’s National Inpatient Sample data to identify medical injures in 7.45 million hospital discharges from 994 acute care hospitals across 28 states in 2000. The study provides, for the first time, specific estimates for excess length of stay, charges, and the risk of death for each of 18 of the 20 AHRQ Patient Safety Indicators, according to the organization.

The results, while disconcerting, did not surprise Zhan. "They basically confirmed what common sense tells us doctors know in the hospital," he says.

Using the information

Zhan points out that the nation’s hospitals can use this information to enhance the efforts they already are making to reduce medical errors and improve patient safety.

"This increases our understanding of the most serious injuries — things we need to pay more attention to," he asserts. "Naturally, hospitals should pay attention to all of them, but nosocomial infections is still the biggest one. This tells us, for example, that we need to do even more in terms of hand washing."

The most legitimate next step is to look at the specific risk factors associated with each injury, "because they are all different with each one," Zhan notes. "For example, with foreign materials left in the body after surgery, the double counting of sponges before and after each operation would be one strategy to adopt. There are a lot of things we can do."

The bottom-line take-home message, Zhan says, is that "Medical injuries can have a devastating impact on the health care system. We need more research to identify why these injuries occur, and to find ways to prevent them from happening."

Need More Information?

For more information, contact:

• Chunliu Zhan, MD, PhD, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. E-mail: czhan@ahrq.gov.