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Hospital Injuries Kill 32,000 in U.S. Each Year

Many of the errors are likely preventable, experts say

TUESDAY, Oct. 7 HealthDayNews) -- Medical injuries in hospitals claim more than 32,500 lives in the United States each year, according to a new finding that such complications lead to at least 2.4 million extra days on the wards and up to $9.3 billion in added costs.

A 1999 report from the Institute of Medicine claimed that medical errors lead to between 44,000 and 98,000 deaths a year in the United States, at an annual cost of $17 billion. The new study, which looked at 18 categories of hospital complications and not the entire gamut, doesn't challenge those estimates. But it does refine the numbers in a way that the previous report could not.

Some complications are the unavoidable risks of treating desperately ill patients, while others are clearly physician error. "This study won't be able to tell you how much is preventable," says study leader Dr. Chunliu Zhan, a senior fellow at the Agency for Healthcare Research and Quality. "But some are more preventable than others."

In the last two years, Zhan's agency, a division of the U.S. Department of Health and Human Services, has used a system for identifying medical injuries in hospital patients that relies on hospital billing records. The method is less taxing and more cost-effective than sifting through medical records, which has been the gold standard of patient safety studies.

For the latest study, Zhan and his colleagues looked at nearly 7.5 million billing records from 2000. The cases covered 994 hospitals in 28 states, representing about 20 percent of all the nation's hospitals.

The researchers, whose report appears in the Oct. 8 issue of the Journal of the American Medical Association, limited their study to 18 categories of complications, called Patient Safety Indicators. These included serious blood infections, bad reactions to transfusions, botched surgeries and trouble during delivery. They tallied the extra days of hospital care attributable to the problems and what they cost to control.

Serious blood infection, or sepsis, following surgery was the most draining complication, leading to an average of nearly 11 extra days in the hospital at a cost of more than $57,000 per patient. Almost 22 percent of patients who suffered post-surgery sepsis died of the infection.

The second most serious medical injury was a rupture, or "dehiscence," of a wound after surgery. Patients with this complication spent an average of about nine more days in the hospital, and racked up $40,000 in extra costs, while nearly 10 percent died of the injury. Infections caused by medical care rounded out the top three, adding more than nine days to a hospital stay at a cost of nearly $39,000 per patient, with a risk of death just over 4 percent.

At the bottom of the list, delivery trouble typically added no days or dollars to a hospital stay -- at least for mothers who delivered vaginally without the help of instruments -- and had no additional risk of death. "Not too many people would die from those injuries," Zhan says. Injuries in women who required instrument help during labor were the most common complication in hospitals, occurring in about 22 percent of such patients -- a "surprisingly high" rate, Zhan says. Again, however, deadly events were rare.

Overall, the researchers say, the 18 types of patient injuries could account for 2.4 million extra hospital days, between $4.6 and $9.3 billion in added costs and roughly 32,500 deaths each year. Future studies may be able to flesh out how many of these truly are preventable, Zhan says.

Dr. Paul Gluck, a Miami obstetrician who sits on several committees at the National Patient Safety Foundation, says some experts may quibble with the Patient Safety Indicators Zhan and his colleague, Dr. Marlene Miller, a Johns Hopkins University pediatrician, used in their study. But as mounting evidence indicates that patient injuries are a problem, "we have to pay attention to that."

Gluck says estimates have put the share of preventable injuries at between 50 percent and 75 percent of the total. The problem, however, is figuring out what the total truly is. One way to do that, he adds, is a confidential, non-punitive reporting system for medical errors modeled on that covering the airline industry. Legislation establishing such a program is now making its way through Congress.

More information

For more on the quality of the nation's health-care system, try the Agency for Healthcare Research and Quality or the National Patient Safety Foundation.

SOURCES: Chunliu Zhan, M.D., Ph.D., senior service fellow, Agency for Healthcare Research and Quality, Rockville, Md.; Paul Gluck, M.D., obstetrician and member, National Patient Safety Foundation, Miami; Oct. 8, 2003, Journal of the American Medical Association
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