- Adverse event rates among hospitalized patients declined significantly from 2010 through 2019 in a large study of medical records for adults admitted for acute myocardial infarction, heart failure, pneumonia, major surgical procedures and other conditions, according to a JAMA investigation.
- The study used data from the Medicare Patient Safety Monitoring System to assess outcomes for 244,542 patients in 3,156 acute care hospitals across the country. It included adverse events such as drug reactions, hospital-acquired infections, problems after a procedure and general issues such as pressure ulcers and falls.
- Although the study found improving trends for adverse events, other researchers, in an editorial published simultaneously in JAMA, said the new report "is an unfortunate reminder that adverse events remain unacceptably frequent."
Adverse events and complications are a persistent concern for hospitalized patients. Leapfrog Group, an advocacy organization for healthcare transparency, has estimated that complications in hospitals harm more than 94,000 patients each year and kill nearly 25,000.
An HHS Office of Inspector General report this year concluded 25% of hospitalized Medicare patients experienced harms in October 2018 alone. The Agency for Healthcare Research and Quality found that specific adverse events such as surgical site infections and pressure injuries increased nationally between 2014 and 2017.
The JAMA study authors acknowledged that more research is needed to understand the extent to which their findings represent a change in patient safety. However, factors in the research support an improved patient safety trend, they said, including use of a national patient safety measurement system, MPSMS, specifically designed to monitor adverse events.
The study showed that from 2010 to 2019, the number of adverse events per 1,000 discharges declined from 218 to 139 for patients initially admitted for acute myocardial infarction, from 168 to 116 for those with heart failure, from 195 to 119 for pneumonia, and from 204 to 130 for major surgical procedures. The rate of adverse events for all other conditions, tracked from 2012 to 2019, was unchanged at 70 per 1,000 discharges.
The overall in-hospital mortality rate fell from 4.6% in 2010 to 2.7% in 2019.
But authors of an opinion piece accompanying the study were critical of how data measurements were taken. Research should focus on whether adverse event outcomes are significantly closer to zero, they argued, rather than how the trends compare with 2010 rates.
None of the adverse event rates crossed a 50% rate reduction, they said. The report also potentially underestimates adverse drug events because the analysis included only events related to digoxin, hypoglycemic agents and anticoagulants, according to the editorial’s authors.