About 1 in 4 patients admitted to a hospital in the United States will suffer, according to a study published Wednesday in the New England Journal of Medicine.
Experts underline the striking findings, that despite decades of effort, hospitals in the US still have a long way to go to improve patient safety.
D., chief of general medicine at Brigham and Women’s Hospital in Boston, who led the study. “These numbers are disappointing but not shocking,” said David Bates. “They show that we still have a lot of work to do.”
The research analyzed the medical records of 2,809 patients admitted to 11 Boston-area hospitals in 2018. The study excluded only those who applied for observation, hospice, rehabilitation, addiction treatment, or psychiatric care.
Hospital data showed that 663 of these patients – about 24% – experienced at least one event during their stay that had a temporary, albeit temporary, adverse effect on their health.
A total of 222 adverse events were considered preventable, meaning one mistake harmed the patient. This corresponds to about 7% of the total applications analyzed by the researchers. Twenty-nine people, or 1% of the admitted total, experienced serious preventable adverse events that resulted in serious injury. One death was considered preventable.
However, most of the bad outcomes were considered unavoidable. These may include known side effects of certain medications or known risks associated with surgery.
Overall, the most common adverse events (approximately 40%) were related to medications given in the hospital. Surgery and other procedures were just over 30%, followed by what the study authors called “patient care events”, with 15%. These include fall and bedsores, both of which are considered preventable.
A bright spot, according to experts, was that hospital-acquired infections only accounted for about 12% of adverse events – a significant drop according to a 1991 study that found infections to be the second most common side effect.
This 1991 study, called the Harvard Medical Practice Study I, is considered landmark research. He used data from patients hospitalized in New York state in 1984 and found that only about 4% of hospitalized patients were injured. However, the study looked for a smaller range of side effects than current research, and hospitals got much better at reporting harm when it occurred.
“At least it’s clear that the rate hasn’t dropped and damage remains a really serious issue,” Bates said.
Johns Hopkins Bloomberg School of Public Health director of the Center for Health Services and Research Results Dr. Albert Wu said in an email that while progress has been made in some areas, new risks are emerging as medicine advances.
“While we removed some of the causes of harm, there were new types of harm associated with new potent drugs and new procedures,” said Wu, who was not involved in the new research.
For example, pharmaceutical companies have made significant progress in the three decades since the last report was published, but the plethora of available drugs offers more opportunities for medication errors.
Honorary president and senior member of the institute, Dr. “There are many more drugs available today than in 1991, and some drugs have a smaller therapeutic margin, which is the gap between therapeutic effect and dangerous dose,” said Donald Berwick. For Health Improvement in Boston. Berwick wrote an editorial published Wednesday along with the new study.
Even technologies implemented to prevent medication errors can create new opportunities for accidents.
“New technologies are always bidirectional and you need to have intense surveillance to watch them. You have to anticipate what could go wrong and build dams around the hazards,” said Berwick.
Linda Aiken, founding director and professor of the Center for Health Outcomes and Policy Research at Penn Nursing in Philadelphia, said staff is at the center of patient safety.
“Since we’ve been doing research on patient safety, we’ve consistently found that one of the main explanations for poor patient outcomes is an insufficient number of nurses at the bedside,” he said. “Having enough nurses is a building block for safety.”
In a 2018 study published in Health Affairs, Aiken and his team interviewed nurses at 535 hospitals in the United States. Sixty percent reported that their hospitals did not have enough nurses to provide safe care to patients. The pandemic infuriated nurses who were already stressed and led to strikes.
Only one state, California, has legal criteria for the minimum number of staff required for safety in a hospital. A nurse cannot care for more than five patients at a time.
“If you truly enforce such a standard, you can save many lives that fall within the scope of patient safety,” Aiken said. These are preventable, but there are very few nurses out there to provide the type of care that will prevent these adverse events from happening.”
Experts said that efforts should be made to prevent damages that are described as unavoidable.
“Applications evolve in such a way that unavoidable bugs can be avoided by changes in the app,” Wu said. “For example, if you stop using a drug completely, [has a] high rate of unavoidable side effects, these negative effects will no longer exist.”
As chief quality and clinical transformation officer at University Hospitals in Cleveland, Dr. Peter Pronovost was working to prevent bloodstream infections that were once seen as “unavoidable rather than preventable.”
“When we changed this narrative and used checklists, we reduced these infections by 80%, which used to kill more people than breast or prostate cancer,” he wrote in an email.
Wu said patients “should keep in mind the potential for harm while being hospitalized.” He encouraged patients to be an active part of the healthcare team and told hospital staff what diagnoses they had made, the medications they used, the allergies they had, and the care they had elsewhere.
“If you think something might be wrong, speak up!” said.
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This article was originally published on NBCNews.com.