Hospital Safety and Patient Deaths

A new study conducted by researchers from Cincinnati Children’s Hospital explored how hospitals determine the schedules for administering drugs to patients. Researchers found that the driving force behind such timing is not patient need. 

Instead, the researchers learned that many hospitals tend to give patients drugs on a schedule that best matches up with their employees’ schedules, though this is oftentimes to the detriment of patients.. 

“For every drug, order times were time-of-day dependent, with morning-time surges and overnight lulls,” the researchers wrote. “These rhythms correspond to shift changes and rounding times.” 

Prioritizing patient care

To get a better idea of how hospitals are creating schedules for doling out medications, the researchers analyzed drug orders and administration for over 1,500 patients in a children’s hospital in 24-hour intervals between 2010 and 2017. The study included data on nearly half a million doses of 12 different drugs. 

Overall, the researchers learned that there was no universal solution here; each patient is unique and responds more positively to different drugs at different times. The finding emphasizes the importance of healthcare professionals checking in with patients to determine what time best suits their needs. 

The study revealed that the hospital tended to wait until morning to dole out most drugs to patients -- once staffing changes had been made -- and this isn’t always the most effective strategy. 

While some drugs are better administered during the patient’s waking hours versus right before bed, other patients need quick pain relief in the middle of the night. The researchers say it’s important for hospitals to take these factors into consideration. 

Listening to what patients need, ensuring that they can avoid painful side effects, and that they are able to rest comfortably throughout the night are essential, and it can be done rather easily in hospitals. 

“There is great potential here to align what we know about drug timing from the last 60 years of research and implement this knowledge in hospitals,” said researcher Dr. David Smith. “There are immediately actionable steps.” 

Being admitted to a hospital ranking lower for preventing accidents, injuries, errors, and infections could greatly increase your chances of not getting out alive.

That’s a principal takeaway from the Leapfrog Group’s annual Hospital Safety Grades. It found that patients in hospitals receiving a “D” or “F” grade were 92 percent more likely to die from an avoidable cause.

The report also found that patients in hospitals receiving a “C” grade were 88 percent more likely to have a patient die an avoidable death. The risk drops to 36 percent for institutions receiving a “B” grade.

While hospitals awarded an “A” grade are not perfectly safe, the researchers found they are getting safer with each passing year. Their report concludes that if every hospital protected against avoidable death at the same rate as “A” hospitals, it would save 50,000 lives annually.

160,000 avoidable deaths

The report found an estimated 160,000 lives were lost in the U.S. in 2017 from avoidable medical errors that are accounted for in the Leapfrog Hospital Safety Grade, a big improvement from 2016, when researchers estimated there were 205,000 avoidable deaths.

"The good news is that tens of thousands of lives have been saved because of progress on patient safety,” said Leah Binder, president and CEO of the Leapfrog Group. “The bad news is that there's still a lot of needless death and harm in American hospitals."  

She points to the report’s underlying conclusion, that U.S. hospitals don't all have the same track record when it comes to keeping patients alive.

“So it really matters which hospital people choose, which is the purpose of our Hospital Safety Grade," Binder said.

Very few received a failing grade

The latest study graded more than 2,600 U.S. hospitals, with nearly a third earning an “A” grade. Fortunately, only 1 percent got a failing grade, while 6 percent were rated “D,” or poor. The states with the highest percentage of A-rated hospitals are Oregon with 58 percent, Virginia with 53 percent, Maine with 50 percent, and Massachusetts and Utah with 48 percent.

There were no A-rated hospitals in Wyoming, Arkansas, Washington, DC, Delaware, or North Dakota.

The Leapfrog Hospital Safety Grades are an independent, nonprofit grading system administered on behalf of employers and other purchasers of healthcare services. They rate institutions on their ability to avoid errors, accidents, injuries and infections and receive guidance from the Johns Hopkins Armstrong Institute for Patient Safety and Quality.

When it comes to certain life and death circumstances, hospital patients are often left with little choice when it comes to the care they need to receive. For example, being put on a ventilator to maintain breathing function can be the only real option for someone who has been in a serious accident.

Unfortunately, using these devices often comes with a risk of its own. Experts say that blood clots, lung damage, and ventilator-associated pneumonia – one of the most pervasive and deadly hospital-acquired infections – are all too common. But a group of researchers from Johns Hopkins Armstrong Institute of Patient Safety say there are ways that consumers and medical staff can reduce the risks.

"These complications prolong the duration of mechanical ventilation, and they keep patients in the hospital longer," said Dr. Sean Berenholtz. "This, in turn, leads to higher complications, higher mortality, higher lengths of stay and higher costs. So decreasing these complications is a national priority and helps our patients recover sooner."

Reducing risks

In a study involving 56 ICUs at 38 hospitals in Maryland and Pennsylvania, researchers attempted to provide medical staff with the most recent and effective evidence-based therapies for protecting patients from ventilator-associated complications. The interventions included:

• Elevating the patient’s head in bed;
• Suctioning the patient’s mouth tube;
• Performing oral care, including tooth brushing and using chlorhexidine mouthwash;
• Performing spontaneous awakening and breathing trials by reducing narcotics and sedatives; and
• Implementing a five-step culture change intervention program focused on reducing harm to patients.

Over the two-year study period, the researchers found that these interventions drastically reduced ventilator-associated events in ICUs by 38%, with infection-related events dropping by over 50%. Cases of ventilator-associated pneumonia also dropped by an astonishing 78%.

Complications are preventable

The study findings give hope to patients and medical professionals, many of whom believed that these dangerous infections and events were unavoidable.

"When patients are sick, complications can happen, and, in some cases, health care-associated infections are thought to be inevitable. . . This is the largest study to date to show that these complications of mechanical ventilation, or ventilator associated events, are also preventable," said Berenholtz.

The full study has been published in Critical Care Medicine.

When people are seriously ill or injured, they are usually admitted to a hospital. But it turns out that a hospital may not exactly be the safest place to find yourself.

In the past, hospitals didn't always have access to the latest treatments. Today, most have excellent capabilities, but they don't always have the resources or systems to handle the patient load. This can lead to breakdowns in safety that can result in patient injures and infections.

According to Leapfrog, which conducts annual hospital reviews, hospital mishaps kill over 200,000 Americans each year, making hospital mistakes the third leading cause of death in the United States.

Making the grade

Since not all hospitals are alike and some have much better safety records than others, it might be prudent to consult the data before selecting a hospital. In the latest Leapfrog Hospital Safety Grade, which judged 2,633 hospitals and assigned letter grades, 844 earned an "A," 658 earned a "B," 954 earned a "C," 157 earned a "D" and 20 earned an "F."

That means 57% of hospitals were ranked as either “excellent” or “good,” and only 6% were found to be “poor” or a “failure.” Of course, that's small comfort for patients admitted to that 6% of hospitals.

Leapfrog found that geography sometimes plays a role, with some states able to attract the best hospital administration and best medical talent. North Carolina is a prime example. It was ranked 19th in spring 2013 for the number of “A” rated hospitals. In the current ranking, it's number five.

Idaho has moved from number 45 – the the bottom of the list in 2013 – to number two today, one reason that the state has begun to attract more retirees. At the same time, Alaska, Delaware, North Dakota, and Washington, D.C., have no “A” rated hospitals.

Not equally competent

"In the fast-changing health care landscape, patients should be aware that hospitals are not all equally competent at protecting them from injuries and infections,” said Leapfrog President and CEO Leah Binder. We believe everyone has the right to know which hospitals are the safest and encourage community members to call on their local hospitals to change, and on their elected officials to spur them to action.”

You might think with hospital errors causing so many deaths each year, health policymakers would carefully keep track of them. However, they don't. The 200,000 figure is only an estimate.

As we reported earlier this year, researchers at Johns Hopkins have called on the Centers for Disease Control and Prevention to create a category for hospital errors, much as it has for other health threats. The researchers say cancer and heart disease tend to get most of the attention. They say that since "medical errors" isn't an official category, it doesn't get the funding it needs.

You can find out how hospitals in your area ranked here.

When you go into the hospital, you trust the medical staff will do everything in its power to make sure you leave alive.

But Johns Hopkins researchers calculate that more than 250,000 people in the U.S. die each year because of medical errors. The researchers say it is difficult to know for sure, however, because the Centers for Disease Control and Prevention (CDC) does not have a category for “medical errors” on death certificates.

If the researchers are correct, mistakes made by health care professionals would be among the most common causes of death. The CDC's third leading cause of death, respiratory disease, kills a far fewer 150,000 per year.

The problem, says Dr. Martin Makary, professor of surgery at the Johns Hopkins University School of Medicine, is medical mistakes have never been recognized in a standardized way of collecting statistics.

“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used,” Makary said.

How do they know?

But if that's true, how can the Hopkins researchers claim that medical mistakes kill a quarter million people each year?

The researchers say they looked closely at four different studies of the medical death rate from 2000 to 2008. Using hospital admission rates, they concluded that 251,454 deaths were caused by a medical error, translating into 9.5% of all U.S. deaths.

That would make medical mistakes the third leading cause of death in the U.S., behind heart disease and cancer.

Previous warnings

The Johns Hopkins researchers are not exactly the first to suggest medical mistakes are a significant health and safety issue. ConsumerAffairs, in fact, has a Hospital Errors and Patient Safety category for articles we've written on the topic over the years.

A study as far back as 2004 projected at least 200,000 annual deaths from medical errors. In 1999, when in-hospital deaths were estimated to be half that, the Institute of Medicine called medical error deaths a national epidemic.

Makary says there is a very practical reason to begin acknowledging, and counting, deaths related to medical errors. Cause of deaths statistics, he says, set public health priorities.

“Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves,” Makary said.

The researchers say most deaths caused by medical errors are not due to the quality or skill of medical personnel. Rather, they suggest poorly designed and inefficient health care systems are a threat to patient health and safety.