Hospitalization injuries prove costly to patients, health care system

October 07, 2003

An analysis of more than 7 million recent discharge records from hospitals in 28 states reveals that a group of 18 medical injuries that occur during hospitalization may account for 2.4 million extra hospital days, $9.3 billion in excess charges, and almost 32,600 attributable deaths in the United States annually.

Reporting in the October 8 issue of the Journal of the American Medical Association, the researchers from the Johns Hopkins Children's Center and the Agency for Healthcare Research and Quality (AHRQ) found that among the 18 patient safety events, severe infection, or sepsis, that develops after elective surgery was the most common treatment-related injury, occurring in approximately 11 per 1000 cases. Sepsis also was associated with the greatest increases in length of stay (11 days), charges ($57,727), and in-hospital mortality (22 percent).

"Many studies have examined at the prevalence of medical errors, but this is one of the first studies to provide significant insight into the adverse effects of particular medical injuries on patients and health care resources," said the study's senior author, Marlene Miller, M.D., M.Sc., director of Quality and Safety Initiatives at the Johns Hopkins Children's Center. She conducted the research while with the AHRQ.

In the study, Miller and her team analyzed discharge records from 994 hospitals nationwide using the AHRQ's established Patient Safety Indicators (PSIs), a set of algorithms used with administrative data that can help identify possible medical injuries occurring during hospitalization. In addition to postoperative sepsis, 17 other PSIs were used for this study, including accidental puncture or laceration, postoperative hemorrhage, complications of anesthesia, and postoperative respiratory failure.

The study used a case-control methodology where each medical injury case identified was compared to up to four control patients from the same institution with the same diagnosis-related group, sex, race, and age category. Once cases of potential medical injuries were identified and matched, the researchers focused on outcome statistics relating to length of hospital stay, financial charges, and in-hospital mortality.

Following postoperative sepsis, the second most serious event was the unintended re-opening of a surgically closed wound, which was associated with 9.42 extra days in the hospital, $40,323 in excess charges, and 9.63 percent attributable mortality.

According to Miller, the study has several limitations related to the reliability of information. "The reliability and validity of the AHRQ's PSIs depend on the accuracy and completeness of specific coding of the administrative data," she said. "Also, the coding system was not designed to identify medical injuries and, therefore, is not clinically precise for this purpose. For instance, some PSIs, such a postoperative hemorrhage, may be in part due to patient conditions and in part due to failure in care."

Nevertheless, she added, the findings are strong enough to suggest that the nation's hospitals "have their work cut out for them in order to reduce these statistics. We need to look beyond the numbers to find the root causes of medical errors so we can prevent them, keep hospital costs down, and ultimately provide the safest possible care for patients."

Chunliu Zhan, M.D., Ph.D., of the AHRQ, was a co-author of this study.
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Johns Hopkins Medicine

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