Health Care Costs and Financing

The cost and impact of medical errors continue long after hospital discharge

Medical errors are costly when they happen to patients in the hospital. The cost and impact of these errors also linger long after the patient is released from the hospital, concludes a new study. Researchers William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., at the Agency for Healthcare Research and Quality (AHRQ) found that the death rate increased by 50 percent and error-related costs rose 20 percent over the 90-day period after patient discharge. What's more, error-related problems increased the likelihood of readmission to the hospital, increasing total length of hospital days by 33 percent.

The researchers analyzed 161,004 patient surgeries identified from a large database of insurance claims data. They examined all medical claims incurred within 90 days after the admission date for 14 potentially preventable adverse medical events (Patient Safety Indicators [PSIs] developed by AHRQ; go to http://www.qualityindicators.ahrq.gov/psi_overview.htm). PSIs ranged from infections due to medical care and transfusion reactions to anesthesia complications and pneumothorax. Medication errors were not included in the study.

The 14 PSIs were responsible for 11 percent of all 90-day deaths after surgery and 2 percent of hospital readmissions. An initial hospital stay involving a PSI was 16.2 days on average. Readmission increased the total length of stay days to 21.5 days (33 percent). Excess 90-day costs likely attributable to PSIs ranged from $646 for technical problems (such as accidental laceration and pneumothorax) to $28,218 for acute respiratory failure, with up to 20 percent of these costs incurred after hospital discharge. These findings suggest that reducing the 14 patient safety events examined in this study can result in significant cost savings at the national level.

See "The impact of medical errors on ninety-day costs and outcomes: An examination of surgical patients," by Drs. Encinosa and Hellinger, in the December 2008 HSR: Health Services Research 43(6), pp. 2067-2085. Reprints (AHRQ Publication No. 08-R079) are available from the AHRQ Publications Clearinghouse.

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