The consumer activist group Public Citizen says it has 10 basic patient safety reforms that could save 85,000 lives and $35 billion annually.
The report "Back to Basics," analyzes the results of several studies of treatment protocols for chronically recurring, avoidable medical errors. Most of the reforms in Public Citizen's report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations.
The financial toll of failing to follow accepted safety procedures is astounding, PC says. Severe pressure ulcers cost an average of $70,000 apiece to treat. A catheter infection costs $45,000. Collectively, avoidable surgical errors cost an estimated $20 billion a year, bed sores $11 billion, and preventable adverse drug reactions $3.5 billion.
"There are many incentives to order expensive tests and procedures and too few rewards for providing basic, sensible care," says David Arkush, director of Public Citizen's Congress Watch division. "As the largest investor in the nation's healthcare system, the federal government should ensure that fulfilling basic patient safety standards is a condition of receiving federal reimbursements."
Public Citizen proposes that healthcare providers:
1. Use a checklist to reduce avoidable deaths and injuries resulting from surgical procedures (this would save $20 billion a year)
2. Use best practices to prevent ventilator-associated pneumonia (this would save 32,000 lives and $900 million a year
3. Use best practices to prevent pressure ulcers (this would save 14,071 lives and $5.5 billion a year)
4. Implement safeguards and quality control measures to reduce medication errors (this would save 4,620 lives and $2.3 billion a year)
5. Use best practices to prevent patient falls (this would save $1.5 billion a year)
6. Use a checklist to prevent catheter infections (this would save 15,680 lives and $1.3 billion a year)
7. Modestly improve nurse staffing ratios (this would save 5,000 lives and $242 million a year)
8. Permit standing orders to increase flu and pneumococcal vaccinations in the elderly (this would save 9,250 lives and $545 million a year)
9. Use beta-blockers after heart attacks (this would save 3,600 lives and $900,000 a year)
10. Increase use of advanced care planning (this would save $3.2 billion a year)
Public Citizen also proposes five steps to ensure near-universal adoption of these reforms:
1. The federal government should leverage its $750 billion annual investment in healthcare to compel providers to use proven patient safety practices. HHS can enact many reforms through the regulatory process. Congress could ensure rapid adoption by including instructions to HHS in legislation.
2. Congress should require HHS to take responsibility for accrediting providers to receive Medicare reimbursements. At present, the federal government delegates most accrediting authority to the Joint Commission, which derives its income from the very hospitals it oversees and denies accreditation to less than 1% of these hospitals.
3. Congress should make significant financial investments to increase the country's supply of nurses and set federal minimums of acceptable nurse-to-patient ratios.
4. Congress should require mandatory reporting of adverse events, including requiring hospitals to institute strong internal reporting, and creating whistle-blower protections for healthcare workers. National reporting of the most serious medical errors is largely left to the Joint Commission. However, that organization estimates that it learns of only about one-tenth of 1% of serious medical errors despite its stated requirement that doctors disclose all errors to patients.
5. Congress should ensure that the requirements for hospitals to report doctor discipline and maintain viable peer review processes are followed. Hospitals have been required since 1990 to report to the federal government cases in which doctors are suspended for more than 30 days. But nearly 50% of hospitals have never reported a single disciplinary action.