By Jeffrey R. Carlson, MD, CPE, FAAOS
Patients come to our medical practices to be treated for conditions that impact their lives. After consultation with the appropriate provider, patients should have a plan for the next steps in their treatment. Patients usually have a reasonable expectation of the American healthcare system, believing they will receive the best and most effective medical care for their condition. When it comes to hospital-based care, there may be a significant disconnect between the treatment they planned to receive with their doctor and the quality of treatment they actually receive.
A recent study published in the New England Journal of Medicine (January 2023) has shed light on the safety of inpatient hospital care. This study looked at the admissions of patients treated in Massachusetts hospitals in 2018. Over that year, they reviewed 2,800 inpatient admissions and found adverse events in 978 patients (23.6%). This is an astounding percentage, but even more jarring is they found that almost 25% of these adverse events were preventable. Adverse drug (39%), surgical/procedural (30.4%), patient-care/nursing (15%), and healthcare-associated infection (11.9%) events were the most reported.
With any treatment, there is a risk of complications. Patients should expect, however, that the most common risks are known and preventable, when possible. That this recent study indicates one in four patients will have a preventable adverse event in the hospital is concerning and suggests that going to the hospital is a risk unto itself.
The research also found this trend to be more significant at large hospital centers, where the actual treatment and decision-making may be done virtually or in a remote location and carried out by those who have little invested in the patient. In this case, the larger medical complex is not better and tends to be more bureaucratic and less patient-focused, which could lead to worsening outcomes and complications.
The concern for practitioners is the more people involved in guiding patient treatment, the more likely there will be an adverse event. Direct communication with staff and providers on the treatment directives and ensuring the team understands the risks of the treatment keeps everyone on track to prevent known adverse events.
The inherent risk of going to the hospital is a key factor in the growth and availability of ambulatory surgical options. Patients can develop a treatment plan with the same doctor performing their procedure, form a bond in the process of that care, and know that their doctor is directly involved in all aspects of their care. With more direct care, there is a lower risk of adverse events. This, in turn, increases patients’ trust in their doctor, decreases costs and improves outcomes. This is the triple benefit of being closely engaged in your patients’ care.
Jeffrey R. Carlson, MD, is the President and Managing Partner of Orthopaedic & Spine Center in Newport News, Va. He holds a fellowship in Orthopaedic Trauma surgery and a combined Neurosurgery-Orthopaedic fellowship in complex spine surgery from Brigham and Women’s Hospital in Boston. osc-ortho.com