US Saw Decade of Patient Safety Improvement Before COVID-19

Adverse patient safety events went down in the decade before the COVID-19 pandemic broke out across the United States, marking a key improvement in the overall patient experience that can be replicable in years to come, researchers from the Agency for Healthcare Research and Quality (AHRQ) wrote in JAMA.

The assessment of some 245,000 patients in over 3,100 hospitals between 2010 and 2019 showed significant patient safety improvements for those experiencing acute myocardial infarction, heart failure, pneumonia, and major surgical procedures, the researchers wrote. This is great news, they added, even amid a backdrop of patient safety dips following the outbreak of COVID-19.

“America’s doctors, nurses, and allied health workers dedicate their professional lives to serving patients and keeping them safe,” AHRQ Director Robert Otto Valdez, PhD, MHSA, said in a press release.

“These study results indicate that we know how to improve patient safety by working together and that we can sustain those results over time,” Valdez added. “The pandemic has undoubtedly put those successes at risk, but this study should provide motivation for healthcare officials to rebuild and rededicate ourselves to a patient and provider safety doctrine.”

Patient safety is at the core of a good overall healthcare experience. Although other factors like good patient-provider communication, a quality hospital environment, and general rapport are effective at building patient satisfaction, healthcare quality is still at the heart of the patient experience.

Healthcare has been at work improving patient safety for over two decades after the seminal report, “To Err is Human,” published by the Institute of Medicine, revealed staggering insight into the rate of adverse patient safety events in this country.

At the time of the 1999 publication, medical errors were killing 98,000 people in the United States every year, the IOM report authors found, outnumbering patient deaths from highway accidents, breast cancer, and AIDS. Deaths from medication errors alone totaled at nearly 7,000 patients annually, exceeding the number of workplace injury deaths, the researchers reported.

The latest from AHRQ found that the medical industry had made some serious headway in reducing adverse patient safety events. Looking at 2010 to 2019 alone, the researchers found notable declines across 21 adverse events, including adverse medication events, infections, and post-procedure events.

The drop in adverse patient safety events was particularly notable among heart attack patients, who saw a 36 percent decline; heart failure patients, who saw a 31 percent decline; pneumonia patients, who saw a 39 percent decline; and major surgery patients, who saw a 36 percent decline.

The researchers said the unadjusted rate of adverse events went unchanged for patients representing all other conditions.

When factoring in certain patient and hospital characteristics, the risk of an adverse event fell among heart attack patients (41 percent), heart failure patients (27 percent), pneumonia patients (36 percent), and major surgery patients (41 percent).

And, importantly, after adjustments, the risk of adverse event dropped for patients with any other condition by 18 percent, the researchers added.

These findings are exciting after the medical industry has made concerted efforts to improve patient safety, AHRQ representatives said.

“This study serves as evidence of what many in the field of patient safety have long believed, that when we work together towards a common goal, rely on the evidence, and attend to individual patient needs, we can achieve great results,” Erin Grace, MHA, acting director of AHRQ’s Center for Quality Improvement and Patient Safety, and another of the study’s co-authors, said in the press release.

“This all-in approach will also be critical to future analyses of the impact the COVID-19 pandemic has had on patient safety,” Grace continued.

The COVID-19 pandemic likely interrupted the headway that was made, as both Grace and Valdez suggested, although a comprehensive study of patient safety and adverse safety event rates hasn’t been published.

Earlier in 2022, patient safety watchdog The Leapfrog Group did publish findings indicating that some patient safety snags remained post-pandemic even as patient experience reports remained positive, at least in pediatric settings.

First, a report focused on pediatric settings said that the patient safety issues stated in the 2022 report existed before the pandemic, like discomfort reporting a medical error.

The Leapfrog Group detailed in a separate report similar trends in adult inpatient care, saying that the pandemic interrupted investments and improvements in patient safety.

“The health care workforce has faced unprecedented levels of pressure during the pandemic, and as a result, patients' experience with their care appears to have suffered,” Leah Binder, president, and CEO of The Leapfrog Group, said in a press release about the adult inpatient care report.

“We commend the workforce for their heroic efforts these past few years and now strongly urge hospital leadership to recommit to improved care—from communication to responsiveness—and get back on track with patient safety outcomes.”

The results from the AHRQ study are promising because they demonstrate that patient safety improvements are indeed possible. Healthcare organizations may invest in technology that helps tamp down on patient safety events, like clinical decision support and big data analytics.

Patient-facing strategies, like strong and clear communication, family engagement, and building relationships that overcome power hierarchies will likewise be important moving forward.