Hospital safety was on the right track before COVID-19, AHRQ reports

In the decade before the COVID-19 pandemic, adverse safety events in hospitals decreased by more than 30%, according to a federally sponsored study published in JAMA Tuesday.

Safety and quality initiatives by health systems reduced adverse events involving infections, medications or surgeries among patients admitted for acute myocardial infarction, heart failure, pneumonia and major surgical procedures between 2010 and 2019, the Agency for Healthcare Research and Quality reports.

“We have every reason to feel hopeful,” David Rodrick, health scientist administrator at AHRQ, said in a statement. “This study shows that efforts by frontline healthcare professionals, organizations, federal agencies and the broader patient safety community have worked. It has taken the entire community focusing on measurable aims, implementing evidence based practices and engaging with leaders.”

An obvious limitation of the findings is they don’t reflect the challenges COVID-19 has posed for hospitals over the past three years.

“While we are excited that this study shows that progress has been made, we will focus efforts on further reducing harm and continue to track the National Hospital Acquired Condition Rate,” Rodrick said. “Early indicators show that at the height of the pandemic some areas of patient harm have increased.”

With stretched hospital resources, delayed care, fewer interactions between patients and clinical staff, and more travel workers, maintaining patient safety has become more difficult, said Dr. Mark Metersky, chief of the division of pulmonary, critical care and sleep medicine at the University of Connecticut School of Medicine and the study‘s lead investigator.

Between 2010 and 2019, adverse event rates fell 36% for heart attack patients, from 218 to 139 events per 1,000 discharges. Rates fell by 31% for heart failure patients, 39% for pneumonia patients and 36% patients undergoing major surgeries. Researchers examined medical records data from nearly 245,000 adult patients at 3,156 hospitals.

The relative risk of experiencing an adverse event declined by 41% for heart attack patients, 27% for heart failure patients, 36% for pneumonia patients, 41% for major surgery patients and 18% for patients with all other conditions.

System-wide advancements over the past 10 years could have contributed to these positive results, Metersky said. Among those are more effective supervision and guidance of medical trainees, greater use of infection control specialists and wider adoption of electronic health records, he said. The Centers for Medicare and Medicaid Services has also implemented financial incentives to promote patient safety, he said.

Patient safety seems to be trending in the opposite direction during the pandemic. Between the second quarters of 2019 and 2020, Centers for Disease Control and Prevention data show a 28% increase in the standardized infection ratio for central-line-associated bloodstream infections, for example. In 2020, critical care facilities saw a 39% increase in the standardized infection ratio, with 1,911 adverse events taking place in that year’s second quarter.

While CMS has continued collecting quality data, it has also suspended some safety measurement and public reporting requirements due to the pandemic’s toll on hospitals This has raised questions about transparency and about health systems’ ability to sustain advances in patient safety.

The big question is what successful hospitals have been doing that led to improvements before the pandemic, said Anupam Jena, associate professor of healthcare policy at Harvard Medical School. Learning why other hospitals didn’t get safer also is key, he said.

In spite of the strain COVID-19 is causing, the pandemic has offered health systems an opportunity to learn lessons that could better equip them to care for patients, Jena said. Once the public health emergency passes, hospitals will be able to regain momentum on on patient safety, he said.

“Whatever we learned, the underlying processes that have been developed over the last decade or so, it’s not going to have vanished because of the pandemic,” Jena said. “The infrastructure will still be there.”