Potential Role of Automated Patient Safety Reporting Systems in Vermont Hospitals
Kenneth E. Thorpe, Ph.D.Robert W. Woodruff Professor and Chair
Department of Health Policy and ManagementRollins School of Public Health
Emory [email protected]
Greater than 50% of the $17 - $29 billion national cost associated with medical errors is preventable.
Source: Thomas EJ, Studdert DM, Newhouse JP et al. 1999. Costs of medical injuries in Utah and Colorado.
Inquiry. 36:255-64.
Major Opportunity
The Key to Long Term Success
Establishing a Safety
Management Program
– Leadership driven– Data-based – Multi-disciplinary– Enterprise wide– Multi-faceted– Foundation for all
improvement initiatives
On average existing patient safety interventions have identified, 10-15% of a hospital’s annual operating budget being spent on resources associated with medical errors and ineffective and failed processes that occur in the care delivery process
The Opportunity
Patient Safety Models Are Integrated into a Hospital’s Information System
Identify Events
Long-term Cultural Change
Error & Cost Reduction& Quality Results
Trend Analysis of Data
Process Engineering
Impact on Errors, Costs, and Malpractice Claims
• Case study from 400 bed community hospital
• Results from 4 key areas– Patient Falls– Medication events– Skin integrity issues– Nosocomial infections
Study Methods
• Total cost of care for (DRG, severity adjusted) patients with error/event less total costs care for all patients in same DRGs.
• Many underestimate reductions since reference group includes all patients --- those with and without a medical error/event.
Results
All Payer 2004 SpendingAll Payer 2004 Spending 2004 Medicare Spending2004 Medicare Spending
$$ % of Total% of Total $$ % of Total% of Total
Medication Events $155,435 0.18% $53,667 0.21%
Total Falls $196,006 0.22% $108,518 0.42%
Total Skin Events $268,652 0.30% $131,350 0.50%
Nosocomial InfectionsNosocomial Infections $591,968 0.67% $252,404 0.97%
TOTAL inpatient savings from 4 areas
$1,212,061 1.37% $545,940 2.09%
Potential savings as a % of all inpatient expenses
$11.9 Million 13.61%
Additional Cost of Care
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
0 5 10 15 20 25 30Over 30 Months
Additional Cost of Care Declining by 2.2% Per Month
Additional Days of Stay
0
200
400
600
800
1000
1200
0 5 10 15 20 25 30
Over 30 Months
SOURCE: APTIS, Inc.
Trend in Medical Malpractice Claims
Total Claims by year
.
1999 2000 2001 2002 2003 20040
20
40
60
80
100
88
99
58
95
67
52
SOURCE: APTIS, Inc.
Patient Safety Outcomes• 16% Relative Reduction in Hospital Fall Rate
• 28% Relative Reduction in Hospital Medication Event Rate
• 0.2% Incidence of Skin Breakdown (0.4-38% National Incidence)
• 40% Relative Reduction in Additional Cost of Care over 30 Months for Adverse Events*
• 50% Relative Reduction in Additional Days of Stay over 30 Months for Adverse Events*
* As Calculated by SafeCare Systems SIS – 400-bed facility
Patient FallsRate per 1,000 Adjusted Patient Days
JanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJul99 00 01 02 03 04
0
1
2
3
4
5
Data Source = SafeCare™ SIS01/99 – 07/04SOURCE: APTIS, Inc.
Medication Events Rate per 1,000 Adjusted Patient Days
JanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJul99 00 01 02 03 04
0
2
4
6
8
10
12
Data Source = SafeCare™ SIS01/99 – 07/04
SOURCE: APTIS, Inc.
Total Skin Integrity IssuesRate per 1,000 Adjusted Patient Days
(Excluding Non-Hospital Acquired and Unstaged Sites)
JanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulyAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJul99 00 01 02 03 04
0
1
2
3
4
5
National Incidence 0.4%- 38%*
Data Source = SafeCare™ SIS01/99 – 07/04SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SOURCE: APTIS, Inc.
SafeCareSafety Information System
Key BenefitsKey Benefits
Identifies the safety opportunities
Manages the organization’s response
Measures the effectiveness of QI initiatives
Quantifies the cost savings