Quality of Care, Medical Errors, Culture of Safety

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Quality of Care, Medical Errors, Culture of Safety

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2023 National Patient Safety Goals – Joint Commission

The Joint Commission (an accrediting body formerly called JCAHO) has adopted national patient safety goals for 2023. Goals apply to Ambulatory Care and Office-Based Surgery, Behavioral Health Care, Hospitals (including Critical Access Hospitals), Home Care, Laboratories, and Nursing Care Centers (Long Term Care). The simplified versions are quick for consumers to read and understand.

Agency for Healthcare Research and Quality (AHRQ)

AHRQ, the Agency for Healthcare Research and Quality, is one of 12 agencies within the Department of Health and Human Services. It is the lead Federal agency charged with improving the safety and quality of America’s health care system. Its mission is to make health care safer, higher quality, more accessible, equitable, and affordable. It also works to help people understand that evidence and put it into practice. FY22 budget is $455 million.

Hospital Survey on Patient Safety Culture (AHRQ) Editor's Pick

The AHRQ Hospital Survey on Patient Safety Culture now has 2.0 results for 2021. The 2021 survey shows an overview of findings from 172 hospitals. Survey results are from 87,856 hospital staff members (47% avg. response rate). While teamwork within units, and supervisors promoting safety received relatively high marks, the staffing and pace of work for staff, as well as handoffs and information exchange, were identified as weaker areas. Staff expressed concerns about having enough staff to handle the workload, and about staff working longer hours than would be best for patient care. Nursing assistants scored the staffing and pace items the lowest. Less than half of staff were positive about hospital’s management being interested in patient safety all the time – not just after an adverse event happens; RNs were particularly critical of this. Staff also scored transferring patients from one unit to another lower, because of important information often being left out. Pharmacists and pharmacy techs scored this last item the lowest.

Some of the lowest scores came from people working on Med/Surg units, Emergency Departments and ICUs. On a composite basis, Administration and Rehab/Physical Therapy scored culture the highest. See Charts 5-1 and 5-2 for the overview. Detailed breakouts by position and department are in the appendixes. Published by the Agency for Healthcare Research and Quality, AHRQ, March 2021. Survey results for 2021 using the 1.0 survey tool are also available, from 320 hospitals and almost 192,000 staff.

Surveys on Patient Safety Culture (SOPS) can also be accessed from this AHRQ web page for medical offices, nursing homes (see listing below), community pharmacies and ambulatory surgery centers.

How Good is US healthcare?

Just how good is US healthcare? Compare the United States with Canada, Australia, France, Germany, Netherlands, New Zealand, Sweden, UK and many other countries on longevity, key healthcare performance measures, and non-medical determinants such as smoking and obesity. 2022 interactive database shows relative actual scores from OECD’s international 2020 and 2021 results. Older results are also shown. In general, the database is complex due to its detail. Many people will have difficulty finding the higher level comparisons they wish. Trends in health expenditures as a percent of GDP are shown. The US outranks all at 17.8% share of GDP (estimated for 2021). An interesting comparison is that the US topped all other countries with 42.8% measured obesity in the total population in 2019, compared to the next country of Mexico at 36% (2018-2020 data). Find obesity under Non-Medical Determinants of Health. Countries like Japan and Korea came in at a 5-7% range. Updated November 2022.

National Healthcare Quality and Disparities Report, 2022

The latest 2022 National Healthcare Quality and Disparities Report (QDR), focuses on hundreds of measures of the quality of healthcare in the US. Midwestern states Minnesota, North Dakota, Wisconsin and Iowa; Northeastern states Maine, Massachusetts, New Hampshire, Pennsylvania and Rhode Island; and western states Colorado and Utah had the highest overall quality scores, 2016-2021. In 2020, an estimated 11.5% of people under age 65 were uninsured. Life expectancy in the United States decreased for the first time in 2020 due to COVID-19. Dated October 2022.

Nursing Home Survey on Patient Safety Culture

The AHRQ Nursing Home Survey on Patient Safety Culture shows staff opinions in the 2023 database. Survey from over 3,200 nursing home staff members provide results on the safety culture for residents in US nursing homes. The survey had a 40% average response rate, from 62 participating nursing homes. While overall perceptions of resident safety, feedback about incidents, and supervisors promoting safety received relatively high marks, there were a number of low-scoring areas. Nursing home staffing received the lowest ratings of any category. Key concerns were having enough staff to handle the workload, and having to hurry or use shortcuts because staff have too much work to do. Perceptions that staff are blamed when a resident is harmed, being afraid to report their mistakes, and staff opinions being ignored in their nursing home also were lower-scoring areas. Staff generally felt that it was hard to keep residents safe because so many staff had quit their jobs. See Charts 5-1 and 5-2 for the overview. Detailed breakouts by position and type of nursing home are in the appendixes. In general, large nursing homes of 100 beds or more scored lower than staff at smaller nursing homes. Only 50% of staff at large nursing homes gave an overall rating on resident safety of “excellent” or “very good”, compared to six out of 10 staff at smaller nursing homes. For-profit nursing homes scored lower than nonprofit or governmental nursing homes. The biggest differences were in resident safety and communication openness. Breakouts of opinions held by nursing assistants compared to other employee groups are enlightening. Published by the Agency for Healthcare Research and Quality, AHRQ, January 2023.

Patient Safety Network, AHRQ

Many resources can be found at AHRQ’s Patient Safety Network website. In the redesigned site, you may have to dig to find what you’re looking for, but it is worth the effort to try. One of our favorite pages is the All Topics page for adverse events and other safety problems, shown here. There are a number of case studies and many journal articles. Includes studies and reports from the National Health Service of the United Kingdom. The Agency for Healthcare Research and Quality is a federal agency.

Patients’ ratings of hospital care are associated with technical quality of care

This article, Patients’ ratings of hospital care are associated with technical quality of care, concludes that patient experience is generally correlated with the quality of care provided. Study was based on a study of 4605 hospitals in 2011. Article by Stein, Day, et al, published in the American Journal of Medical Quality, July-August 2015. Full article linked.

QIO Listings: Quality Improvement and Innovation Organizations

Find a list of Quality Improvement and Innovation Organizations – QIOs. The mission of the QIO program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. It has been modified to incorporate Quality Innovation Networks and complaints on behalf of patients and beneficiaries. Find a Quality Improvement Organization here, searchable by state. Updated 2022.

Readmissions to hospital in 30 days

A new report shows data on hospital readmissions within 30 days following an initial hospitalization. In 2018, the readmission rate for all payers combined was about 14 per 100 admissions. The average cost was $15,200. For a private insurance patient, the readmission rate was lower, but the average cost was higher, at $16,400. Charges would have been higher, but are not shown. Hospital readmissions are an important measure for assessing performance of the health care system. One strategy for improving health care quality and lowering costs is to reduce rates of preventable readmissions. High numbers of return to hospital occurred for septicemia. The second most common category was heart failure. The highest rate (36.1%) was for sickle cell trait/anemia. For Medicaid readmissions associated with sickle cell, the cost was close to $20,000 HCUP Statistical Brief #278 was published by AHRQ July 2021.

Other Helpful Listings

CEO Concerns: Top Hospital Issues, 2022

ACHE annual survey asked hospital CEOs to identify their top three issues of concern in 2022. The overwhelming number one choice was “Workforce Challenges”. This new category includes “Personnel shortages” that had been asked about in prior surveys. Within Workforce Challenges, 90% cited shortages of RNs and 83% cited technician shortages. Concern over burnout of non-physician staff was also high on the list. Again in 2022, Financial Challenges came in second. The biggest financial challenge was increasing costs for staff, supplies, etc. The third-ranked concern was Behavioral health and addiction issues, where concerns included lack of appropriate facilities in the community and lack of funding. Concern over Patient safety and quality slipped to fourth, tied with Governmental mandates. Response rate 21%, by the American College of Healthcare Executives. Updated February 2023.

Chartbook on Patient Safety

The Patient Safety chartbook is part of the National Healthcare Quality and Disparities Report. It shows the progress made on lowering infections, hip or knee replacement adverse events, adverse drug events, cardiac bypass readmissions, home health care improvement, frequency of safety issues in medical offices, and patient safety culture. Rates shown to about 2020 (in some cases, data only to 2019; some of the culture surveys have data as recent as 2022). Published March 2023 by AHRQ.