Health Care; Experiencing harm in hospital significantly increases the length of stay, length of recovery after discharge and health system costs; which amounted to more than $1 billion in Ontario in fiscal year 2015/16; according to new research in CMAJ. “They were able to estimate, for the first time, the total health system impact of hospital harm in Ontario,” says Lauren Tessier, Ph.D. “This amounted to more than $1 billion in 2017 Canadian dollars and 407, 696 acute hospital days equivalent to a 1117 bed hospital operating at 100% capacity every day for a year.”
Using new hospital harm methodology developed by the Canadian Institute for Health Information (CIHI) to measure adverse events; so the study provides useful information on the total cost to the health care system; hence from a harm experienced in hospital as well as subsequent health care usage. Researchers used person centred episodes of care (PCEs) to look at the entire use of health care services; so from the adverse event in hospital through all related hospital and post-discharge care; until an individual had return to the community and was stabilize for 30 days without any further admissions.
Health care readmissions
They looked at harm in four categories: health care/medication, infection, patient accidents and hospital procedures. “The PCE methodology enables all acute and post acute care, including hospital, physician, pharmacy and home care readmissions; to be captured in the episode of care an important advance; so as many studies on the costs of adverse events have treated readmissions as initial admissions, leading to bias,” says Tessier.
The study include 610 979 patients aged 18 to 105 years in Ontario; who had an acute hospital admission between April 2015 and March 2016. Of all patients in the study; 36,004 (6%) experience a harm during their first hospital admission during that period. The most common harm was in the health care/medication associate conditions category; making up half (50%) of all harms. The additional length of stay for patients who experience hospital harm range from 0.4 days (pregnancy PCE) to 24 days (mental health PCE). Costs range from $800 to $51,067 for an unplanned surgical PCE.
Benefit policy makers
“Our finding that hospital harm significantly increases length of PCE is a novel contribution to the literature, as the PCE methodology has only recently develop,” says Tessier. In a link commentary, Drs. Lauren Lapointe-Shaw and Chaim Bell, internal medicine specialists, University of Toronto, Toronto, Ontario, write, “The link study will benefit policy makers in several ways: the authors have clarify the costs of adverse events in Canada, provide a baseline from which to assess changes over time, quantify the investment that could be justify to prevent adverse events and offer estimates to be use in economic evaluations of future interventions.
Because most interventions target a particular condition, costing by type of adverse event would be a valuable addition. The substantial costs of adverse events are far-reaching and cannot be ignored. An improve understanding of their overall impact can only reinforce our efforts at preventing them.” “The impact of hospital harm on length of stay, costs of care and length of person centre episodes of care: a retrospective cohort study” is publish August 12, 2019.