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Results of Safety Efforts for Hospitalized Patients Are Mixed

Results of Safety Efforts for Hospitalized Patients Are Mixed

In-hospital adverse events in the U.S. down for some conditions, but not others

THURSDAY, Jan. 23, 2014 (HealthDay News) -- Based on Medicare data for 2005 through 2011, adverse-event rates declined for patients hospitalized for some conditions, but not others, according to research published in the Jan. 23 issue of the New England Journal of Medicine.

Yun Wang, Ph.D., of Harvard University in Boston, and colleagues analyzed data from 61,523 Medicare patients hospitalized between 2005 and 2011 for acute myocardial infarction (MI; 19 percent), congestive heart failure (25 percent), pneumonia (30 percent), and conditions requiring surgery (27 percent). The authors sought to examine trends in adverse events.

The researchers found declines among hospitalized patients in the adverse-event rate and the proportion of patients with at least one adverse event for those with acute MI (5.0 to 3.7 percent [95 percent confidence interval (CI), 0.7 to 1.9] and 26.0 to 19.4 percent [95 percent CI, 3.3 to 10.2], respectively) and those with congestive heart failure (3.7 to 2.7 percent [95 percent CI, 0.5 to 1.4] and 17.5 to 14.2 percent [95 percent CI, 1.0 to 5.5], respectively). No significant declines in adverse-event rates occurred in patients hospitalized for pneumonia or conditions requiring surgery.

"Several events -- such as contrast-induced nephropathy, which has received little attention in patient-safety initiatives -- increased significantly among patients with acute myocardial infarction, those with pneumonia, and those with conditions requiring surgery," the authors write. "In addition, there was no decline in ventilator-associated pneumonia (except in patients with congestive heart failure), and pressure ulcers increased in surgical patients and showed no significant change in medical patients."

Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMsa1300991 )