Majority of Deaths Detailed in Report Result from Complications Linked to Poor RN Staffing Levels – Study Underscores Need for Bill to Set Safe Limits on Patients Assigned to Nurses
Massachusetts, the self-proclaimed “Medical Mecca”, ranks 22nd in Patient Safety
Canton, Mass.—Preventable medical errors in hospitals continue to be a leading cause of death and injury in the United States, and the effort to improve patient safety by the hospital industry “is too slow and should be cause for great alarm,” according to a study released last week by HealthGrades, a research firm that analyzed the prevalence of patient safety incidents for Medicare patients at every U.S. hospital.
“The majority of complications and deaths reported in this study are linked to problems associated with poor RN staffing levels in hospitals and the study’s findings underscore the need for pending legislation, H. 2663, that would protect patients by setting safe limits on the number of patients assigned to registered nurses,” according to Julie Pinkham, RN, executive director of the Massachusetts Nurses Association, one of more than 100 organizations that are promoting passage of the measure.
The “Third Annual Patient Safety in American Hospitals’ Study,” the largest annual study of its kind, examined the records of Medicare beneficiaries treated at about 5,000 hospitals nationwide between 2002 and 2004 and used 13 patient safety indicators developed by the federal government to track admissions. Key findings include:
- More than 250,000 patients died as a result of preventable medical errors between 2002 and 2004, a death toll that would rank medical errors as the sixth leading cause of death in American, ahead of death due to diabetes, liver disease and pneumonia.
- Approximately 1.24 million total patient safety incidents occurred between 2002 and 2004, compared with 1.14 million between 2000 and 2002.
- The patient safety incidents were associated with $9.3 billion in excess costs during the years studied.
- Massachusetts, often touted as a “Medical Mecca,” ranks a disappointing 22nd in the nation for overall patient safety, and has a similar ranking on all 13 of the patient safety indicators used in the study to measure the quality and safety of care.
- The authors attributed the majority of the preventable patient deaths to "failure to rescue" (which refers to nurses and physicians failure to promptly diagnose and treat conditions that develop in a hospital), bedsores and postoperative sepsis (a serious bloodstream infection).
"Overall, we see the number of patient-safety incidents in American hospitals continuing to increase, at an enormous cost, and we still see a large gap between the incidence rates at the nation’s top-performing and worst-performing hospitals," said Dr. Samantha Collier, vice president of medical affairs for Golden, Colorado-based HealthGrades, in a prepared statement.
Safe Staffing has been Linked to Reductions in Errors and the Costs of Treating Them
Improving RN-to-patient ratios has been shown in a number of studies to prevent or reduce the types of errors identified in the study, including:
- JAMA reported that for every patient in addition to four assigned to a nurse, the risk of death and failure to rescue increase by 7 percent. The author of the study concluded that legislation to regulate RN-to-patient ratios was a credible approach to improving patient safety in hospitals.
- The Joint Commission of Accreditation of Healthcare Organizations linked poor staffing to 25 percent of serious medical incidents.
- The New England Journal of Medicine found that better RN-to-patient ratios could reduce failure to rescue and sepsis by 6 percent.
- The DPH reports a 60 percent increase over the last five years in the number of medical errors, patient falls, complications and complaints by Massachusetts hospital patients.
- A survey of recent patients in Massachusetts hospitals conducted in March 2005 found that 1 in 4 reported their safety was compromised during their hospital stay because their nurse had too many patients.
- The Journal Medical Care reported last August that improving RN-to-patient ratios would save as many as 70 thousand lives, and is more cost effective than other common patient safety measures, including clot-busting medications for heart attacks and strokes, and certain types of cancer screenings.
- The journal Health Affairs reports that an “unequivocal business case” can be made for increasing the level of registered nurse staffing in hospitals—a move that could pay for itself in fewer patient deaths, shorter hospital stays and decreased rates of costly medical complications.
According to MNA president Beth Piknick, RN, this recent report validates the vital role nurses play in preventing harm to patients. “Nurses are the surveillance system in the hospital. We are there to monitor a patient’s condition, administer medications and treatments, and to notice when problems arise and then work with physicians to take appropriate actions. When we have too many patients, as most nurses do every day in Massachusetts, we are more apt to miss these subtle changes, and failure to rescue occurs,” Piknick explained. “This report makes clear that the hospital industry is failing to provide the conditions to safely care for patients.”
The nurses’ bill, H. 2663, An Act Ensuring Patient Safety, is sponsored by Rep. Christine Canavan, RN (D-Brockton) and Sen. Marc Pacheco (D-Taunton). It has 106 co-sponsors with a majority in both branches. The bill sets minimum standards for RN-to-patient ratios that would be adjusted to reflect the types of hospitals units and the severity of patient conditions. It would also ban the use of mandatory overtime for nurses, prohibit requirements for nurses to practice in areas of the hospital for which they are not appropriately prepared and prohibits the replacement of registered nurses with lesser qualified, unlicensed personnel—all of which are common practices in the hospital industry that contribute to the deterioration in patient care identified in recent years.