US hospital side effects dropped significantly

The largest-ever medical records-based study of adverse events suffered by hospitalized patients in the US, is published in the July 12 issue of JAMA, reported a significant reduction in the rate of adverse events over the past decade. The study findings are promising for patient safety and the effectiveness of hospital patient safety initiatives.

In this study, the unidentified medical records of 244,542 patients in 3,156 US hospitals over 10 years were examined. The researchers used the Medicare Patient Safety Monitoring System (MPSMS), a surveillance system administered by the Agency for Healthcare Research and Quality (AHRQ) designed to assess 21 in-hospital side effects in patients with the primary condition acute myocardial infarction (heart attack). heart failure, pneumonia, major surgical procedures, and all other conditions. The relative risk was adjusted for the patient’s age, gender, race, ethnicity, specific comorbidities, and the characteristics of each hospital.

The investigators reported that the rate of adverse events decreased significantly between 2010 and 2019 in patients treated for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures. Some of the recorded side effects include drug side effects, hospital-acquired infections, procedural complications, pressure sores and falls.

“Our study is the largest and most comprehensive assessment of adverse events in hospitalized patients in the US based on a detailed analysis of conflicting medical records with billing data, which can be misleading,” said co-author Dr. Mark Metersky, professor of medicine at UConn School of Medicine and head of the Division of Pulmonary, Critical Care and Sleep Medicine at UConn Health. “There have been improvements in patient safety in US hospitals over the 10 years we studied. Our data suggest that the major safety improvement efforts being made by our country and our hospitals appear to be paying off.”

The investigators evaluated in-hospital trends in the number of adverse events per 1,000 hospitalizations. For example, side effects among patients who had a heart attack decreased significantly over a decade from 218 in 2010 to 139 per 1,000 patients discharged in 2019; in heart failure patients, side effects fell from 168 to 116; in pneumonia patients from 195 to 119; and in major surgery patients, from 204 to 130. However, for those with other conditions no change was observed in the number of adverse events over the same time period; however, reductions were seen in these first four and fifth groups also when comorbidities and other factors, such as patient age, were taken into account.

Interestingly, the investigators observed a greater increase in the rate of adverse events in the older than the younger patients, and there were some marked differences in risk by patient’s race, ethnicity, gender or region of treatment in the US. All groups saw similar reductions. However, patients who experienced adverse events during the study period had significantly higher mortality rates and longer hospital stays than those who did not experience side effects.

The study was funded by AHRQ and the Centers for Medicare and Medicaid Services (CMS). At AHRQ, the collaborative research work was led by Noel Eldridge, who was the first author of the paper. Metersky from UConn is the clinical lead for MPSMS and a co-author with collaborative researchers from Yale, CMS, Federal ONC, Harvard, and others.

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