Ask most people where they think they would be safest if they were sick or injured, and they would say without hesitation "In the hospital." But they'd be wrong. Unfortunately in some cases, dead wrong.
"During this decade, several studies by the Institute of Medicine revealed that more than 1.5 million Americans are injured every year by drug-related mistakes alone, resulting in at least $3.5 billion in extra medical costs just to treat those injured in hospitals. A consensus of other studies revealed that as much as an additional $25.5 billion in costs may be attributable to non-medication mistakes (surgical errors, preventable falls, infections, etc.)"
Even worse, nearly 10%, or 98,000 patients, die from these medical mistakes each year.
Employers, as the access point for the health insurance the majority of these patients rely on, have an important role to play in improving these startling outcomes.
Medication mistakes
As many as 1 million serious drug errors occur every year in hospitals. A study by the Archives of Internal Medicine found that 20% of medications dispensed in 36 hospitals and nursing homes were the wrong drug, the wrong dose, given to the wrong patient or given at the wrong time.
Even poor penmanship can be fatal. An inability to read a doctor's orders can result in the wrong medication, wrong dosage or both.
Most experts believe the best solution is a computerized drug-ordering system linked to the hospital's pharmacy.
This would prevent misreadings and patients' being given potentially lethal combinations of medications.
Surgical snafus
Incorrect surgeries have occurred with enough frequency to prompt the Joint Commission, which evaluates and accredits more than 15,000 hospitals and other health care organizations, to issue two warnings since 1998.
But due to physician resistance, the problems persist.
Wrong-site surgery happens mostly in bone-related operations.
Marking the correct sight in indelible ink is certainly a logical step to take, and last year, 70% of orthopedists began marking operation sites, in compliance with the recommendation of the American Academy of Orthopedic Surgery.
Hospital hygiene
Nearly 2 million infections happen in the hospital, causing 90,000 deaths, just because doctors and nurses don't disinfect themselves before they operate or touch patients.
This adds an average of $38,000 to a hospital bill.
Too much work for new doctors
Forcing interns and residents to work extended hours means they are treating patients when they are tired and prone to mistakes.
Newer doctors are less expensive for the hospital, but fatigued physicians and nurses make more mistakes than those who are alert.
This problem is being investigated by the federal Agency for Healthcare Research and Quality, and Congress is considering laws that would set a limit on how many hours a resident can work per week.
In addition, one residency accreditation program is calling for shorter hours, and some hospitals are now requiring at least one experienced physician to supervise residents and interns around the clock.
Too few nurses
The nationwide shortage of nurses - a reported 126,000 vacancies - results in heavy caseloads for the nurses who are on duty.
The Joint Commission reports that 1,600 serious errors in the past five years involved nurse understaffing.
Over half of the nation's hospitals are using temporary nurses to compensate for this shortage.
But health teams that have a history of working together perform better than those whose members are less familiar with each other.
One solution includes increasing the incentives - wages, benefits and working conditions - to attract qualified nurses.
What employers can do
Although employers might believe they have little recourse in changing these systemic problems, as the ones that pay for most patients' health insurance, there are several steps they can take to encourage improvements:
- Refuse to pay hospitals for costs incurred due to medical errors. Make it a major feature of your health plan contracts.
- Obtain report cards on hospital safety and share them with employees. Check with your state or local business coalition on health to determine whether they have such data.
- Prepare medical plan contracts with hospitals that link reimbursement to safety and quality.
- Impress on hospitals, health plans and heath care providers the urgency to improve safety.
- Recommend that hospital recordkeeping and reporting become fully automated.
- Encourage hospitals to adopt reasonable work schedules for doctors, nurses and other health care providers.
- Determine whether employers serving on hospital boards are safety-conscious and quality-conscious.
- Recognize (with an award or notice in your publications) hospitals that are excelling or have improved in patient safety.
- Request information from groups advocating hospital safety (see sidebar). Ask to be placed on their mailing lists.
Groups taking action
These organizations have sponsored efforts to create a culture of safety within hospitals:
Gathers and reports information on hospital quality and patient safety efforts to help patients make informed decisions about where to receive hospital care. A search function on its Web site provides information on local hospitals.
National Business Group on Health
NBGH's membership comprises several hundred of the nation's largest employers. The group was among the first to urge employers to make hospital safety a priority and issue, for public consumption, a list of recommendations for this purpose. NBGH prepared a toolkit that provides data on employer costs, requirements for hospitals to achieve "preferred" or "center of excellence" status, state ruls and regulations, employee education and guidance for hospital boards.
Agency for Healthcare Research and Quality
AHRQ has launched an initiative to reduce medical errors and improve patient safety in federally funded health care programs and in the private sector. Its Web page includes over 75 links to patient safety information.
Institute for Healthcare Improvement's 5 Million Lives Campaign
Designed to protect patients from 5 million incidents of medical harm over the next two years (December 2006 to December 2008)
National Patient Safety Foundation
Seeks to improve patient safety through a five-step program involving all stakeholders, which includes raising public awareness and fostering communication.
Jan Peter Ozga is the president of Medical Business Exchange, a health care marketing and communications firm based in Vienna, Va.
