miércoles, 15 de junio de 2016

JAMA Network | JAMA | Improving Safety for Hospitalized Patients:  Much Progress but Many Challenges Remain

JAMA Network | JAMA | Improving Safety for Hospitalized Patients:  Much Progress but Many Challenges Remain

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AHRQ Leaders Highlight Hospital Safety Gains, Note Challenges in JAMA Viewpoint

A viewpoint article in the June 13 issue of JAMA documents improvements in hospital safety, including a decline in adverse events from 145 events per 1,000 hospitalizations in 2010 to 121 per 1,000 in 2014. The article, "Improving Safety for Hospitalized Patients: Much Progress but Many Challenges Remain," is co-authored by Richard Kronick, Ph.D., a former AHRQ director; Sharon Arnold, Ph.D., AHRQ’s deputy director; and Jeffrey Brady, M.D., M.P.H., director of AHRQ’s Center for Quality Improvement and Patient Safety. The viewpoint notes that progress was stable between 2014 and 2015, and that patient safety efforts must be expanded to nursing facilities and outpatient settings. The article identifies four activities needed to advance progress: additional evidence about what works to reduce harms, better tools to help providers provide safer care, development of less burdensome and more reliable methods for measuring adverse events and making sure that improving safety remains a high priority for hospital administrators and governing boards. Access the article.

Viewpoint | 

Improving Safety for Hospitalized PatientsMuch Progress but Many Challenges Remain FREEONLINE FIRST

Richard Kronick, PhD1,2; Sharon Arnold, PhD2; Jeffrey Brady, MD, MPH2
JAMA. Published online June 13, 2016. doi:10.1001/jama.2016.7887
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The 1999 publication of To Err Is Human from the Institute of Medicine focused attention on the need to improve the safety of medical care and spurred a variety of public and private responses. Despite this attention, at the 10-year anniversary of that report, there was little evidence that safety had improved, and concern that progress in reducing patient harms in hospitals has been slow.1
It is now clear, however, that over the past few years hospitals have made substantial progress in reducing harms. This Viewpoint reviews the evidence demonstrating progress and what is known about the factors contributing to progress.
The Medicare Patient Safety Monitoring System (MPSMS) provides the only source of reliable nationwide estimates on a broad range of patient harms. The MPSMS uses a structured protocol to review medical records to detect indications that adverse events associated with harms have occurred to patients while hospitalized.2 The system captures 21 different types of harms, including adverse drug events, falls, pressure ulcers, and a variety of hospital-acquired infections such as central line–associated blood stream infections and catheter-associated urinary tract infections (CAUTIs).
Analysis of data from the MPSMS showed that from 2005 to 2011 the rate of adverse events declined by approximately 8% and 5% per year for Medicare patients hospitalized for acute myocardial infarction and congestive heart failure, respectively, but did not change significantly for patients with pneumonia or those who had been hospitalized for major surgery.3 The analysis was among the first to demonstrate systematic nationwide improvement in safety. However, the analysis showed a mixed picture, with safety improving for some patients but not others, and was restricted to Medicare beneficiaries.
More recent results released by the Agency for Healthcare Research and Quality (AHRQ) showed that the rate of adverse events among all hospitalized adults declined from 145 adverse events per 1000 hospitalizations in 2010 to 121 events per 1000 hospitalizations in 2014, a decline of approximately 4.5% per year, and provided evidence of substantial improvements in hospital safety across the nation.4 The analysis considered a broad range of adverse events, including central line–associated blood stream infections, CAUTIs, falls, pressure ulcers, and adverse drug events. Many of these adverse events resulted in serious harms to patients. The analysis estimated that there were a cumulative 2.1 million fewer harms to patients over the period 2010 to 2014 than would have occurred if the adverse event rate had remained at the 2010 level, with a projected estimate of tens of thousands fewer deaths and billions of dollars in cost savings.4

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