The impact of hospital harm on length of stay, costs of care and length of person-centred episodes of care: a retrospective cohort study

Abstract

P atient safety is a key component of high-quality health care delivery as well as an expectation among patients and caregivers. Substantial interest in improving patient safety was prompted following the release of the Institute of Medicine's seminal report, To Err is Human, 1 which estimated that between 44 000 and 98 000 Americans died each year as a result of medical mistakes, with an associated cost between US$17 billion and $29 billion. The Canadian Adverse Events Study followed shortly thereafter and estimated that, in 2000, about 185 000 hospital admissions were associated with an adverse event, and close to 70 000 of these were potentially preventable. 2 Despite the substantial attention these findings generated and the policy initiatives they inspired, 3,4 hospital-based adverse events remain a prevalent issue. 5,6 Recently, the Canadian Institute for Health Information (CIHI) partnered with the Canadian Patient Safety Institute to develop a measure of adverse events in hospital-termed "hospital harm"-using administrative health data. 7 This measure is analogous to the Agency for Healthcare Research and Quality's Patient Safety Indicators 8,9 and enables a renewed attention on surveillance of patient safety specific to a Canadian setting. Although it is understood that experiencing harm in hospital increases length of hospital stay, 5,9,10 costs of hospital care, 9-17 risk of death 9,11,14 and risk of re-admission, 11,14 there is a lack of information on the relation between hospital harm and total cost inclusive of postdischarge use of health services and accompanying costs. 14 In this study, our objective was to assess the impact of hospital harm on the incremental length of hospital stay, as well as on RESEARCH HEALTH SERVICES

A qualitative study exploring the lived experiences of deconditioning in hospital in Ontario, Canada

“…Patient safety, defined by the World Health Organization as “the absence of preventable harm” [ 1 ], is a seminal concept in healthcare and is a focus of policy-makers worldwide [ 2 , 3 ]. Despite efforts to improve patient safety, recent research suggests that hospital-based patient harm remains an ongoing issue [ 4 – 6 ]. Preventable harm often includes healthcare/medication-associated conditions (e.g., delirium, pressure injuries, medication incidents), healthcare-associated infections (e.g., urinary tract infections, sepsis, pneumonia), patient accidents (e.g., falls), and procedure-associated conditions (e.g., laceration, pneumothorax, device failure) [ 7 ].…”

Measuring the cost of adverse events in hospital

“…Any applications of Tessier and colleagues' cost estimates must also account for uncertainty in the proportion of adverse events that are preventable. 6 For example, a cost-effectiveness analysis would need to include a preventability coefficient to appropriately scale the predicted effect of any intervention. Along with adverse events, avoiding hospital readmissions has been a growing focus in the United States and Canada over the past decade.…”

“…Yet, health administrative data algorithms do not permit a nuanced assessment of which adverse events could have been prevented by optimized care. 5 As Tessier and colleagues note, 6 estimates of the degree of preventability vary -from 37% in the Canadian Adverse Events…”

Nursing students’ experiences of patient safety incidents and reporting: A scoping review

“…More recent, additional Canadian findings further suggest 6% of admissions involve harm. [3] Findings from other countries are equally concern-ing, with Makary and Daniel [4] indicating medical error is the third leading cause of death in the United States. Although efforts to reduce PSIs have focused on the clinical practice settings, strategies must also be integrated into curricula for pre-licensure health professionals.…”