Inflammatory headline? Yes. True? Sadly… also yes. Scary fact of the week: “Medical errors kill enough people to fill four jumbo jets a week,” according to a recent article in the Wall Street Journal by Dr Marty Makary, a surgeon at Johns Hopkins Hospital. Not scared yet? Try this one on for size. “Roughly a quarter of all hospital patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America – just behind accidents and ahead of Alzheimer’s disease.” That’s an estimated 98,000 preventable deaths a year1. According to a recent study by David Classen published in Health Affairs, the most common adverse events are medication errors, followed by surgical errors, procedure errors, and hospital acquired infections2. The bit that really sticks out to me is hospital-acquired infections.
Because these include pressure ulcers and catheter associated urinary tract infections (CAUTI).
CAUTIs account for 40% of all hospital acquired infections 3. They are the single most common hospital acquired infection in US hospitals today and costs over $2 billion in additional healthcare costs each year4.
The overuse of indwelling urinary catheters among hospital patients predominantly causes CAUTI5. Some indwelling catheters are medically necessary, others are there for the nurses convenience and others are only necessary for a portion of the patients stay (such as when they are under anesthesia) but are left in for longer than medically necessary. In 2010, the Centers for Disease Control estimated that more than 560,000 hospital acquired UTIs occur each year and cause over 13,000 attributable deaths annually6.
Sustained pressure against the skin that prevents an adequate supply of blood from getting to the skin and underlying tissues causes Pressure Ulcers..
This problem is exacerbated by people’s skin being compromised by constant exposure to moisture (what happens when they are forced to wear diapers for incontinence). Pressure ulcers are avoidable and cost the healthcare system $11 billion each year7. I won’t subject you to any pictures of pressure ulcers here but if you’re curious, google it. It’s nauseating.
But at the end of the day, what does all this mean for you?
It means that it is entirely possible to go into the hospital for a relatively minor procedure and be released worse off than when you went in. Surely that is something we can change. For example, we can eliminate medically unnecessary indwelling catheters. Sounds simple, right? We’ve tried. Men’s Liberty is a healthier alternative that can replace medically necessary Foley catheters. With over one million units sold, there hasn’t been a single reportable adverse event caused by the device including urinary tract infections or skin injuries.
In fact, this one change could save facilities billions and lower their infection rates.
But they won’t do it because the product costs slightly more up front. Product purchases and complication costs are paid out of two different pots of money within the hospital. So purchasing managers see no financial benefit to them. That’s a HUGE problem.
However, Dr Makary listed five action points for decreasing medical errors. Online dashboards, safety culture scores, cameras, open notes and no more gagging – but I have one more to add. Hospitals should have at least one high ranking individual responsible for taking a broader view. To look at how small changes in one area could pay dividends elsewhere and guides decision making accordingly. Controlling healthcare costs in the long term means looking at the forest, rather than the trees.
To Err is Human: Building a Safer Healthcare System, published by the Institute of Medicine, November 1999, See online: https://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
Classen, David, "Medical errors in the USA: human or systemic?," The Lancet, Volume 377, Issue 9774, Page 1289, 16 April 2011. View online: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960520-5/fulltext?rss=yes
Kunin, Calvin M., "Nosocomial Urinary Tract Infections and the Indwelling Catheter: What is New and What is True?" Chest 2001; 120: 10-12.
Calculated from TMIT-APIC Healthcare Associated Infections Cost Calculator. Available online at: https://www.apic.org/Content/NavigationMenu/PracticeGuidance/GuidelinesStandards/Cost_Calculators.htm.
Munasinge, Rijika L. et al., "Appropriateness of Use of Indwelling Urinary Catheters in Patients Admitted to the Medical Service," Infection Control and Hospital Epidemiology, October 2001; Vol 22, No. 10: 647-649
Gould, Carolyn, "Catheter-associated urinary tract infections (CAUTI) toolkit" Centers for Disease Control and Prevention, Available at: https://www.cdc.gov/HAI/pdfs/toolkits/CAUTItooklit_3_10.pdf
Reddy, M., Sudeep, G., Rochon, P., "Preventing Pressure Ulcers: A Systematic Review," Journal of the American Medical Association, 2006; l296: 974-984.