Potential Role of Automated Patient Safety Reporting Systems in Vermont Hospitals Kenneth E. Thorpe, Ph.D. Robert W. Woodruff Professor and Chair Department of Health Policy and Management Rollins School of Public Health Emory University

Greater than 50% of the $17 - $29 billion national cost associated with medical errors is preventable. Source: Thomas EJ, Studdert DM, Newhouse JP et al Costs of medical injuries in Utah and Colorado. Inquiry. 36: Major Opportunity

The Key to Long Term Success Establishing a Safety Management Program –Leadership driven –Data-based –Multi-disciplinary –Enterprise wide –Multi-faceted –Foundation for all improvement initiatives

On average existing patient safety interventions have identified, 10-15% of a hospitals annual operating budget being spent on resources associated with medical errors and ineffective and failed processes that occur in the care delivery process The Opportunity

Patient Safety Models Are Integrated into a Hospitals Information System Identify Events Trend Analysis of Data Process Engineering Long-term Cultural Change Error & Cost Reduction & Quality Results

Impact on Errors, Costs, and Malpractice Claims Case study from 400 bed community hospital Results from 4 key areas – Patient Falls – Medication events – Skin integrity issues – Nosocomial infections

Study Methods Total cost of care for (DRG, severity adjusted) patients with error/event less total costs care for all patients in same DRGs. Many underestimate reductions since reference group includes all patients --- those with and without a medical error/event.

Results All Payer 2004 Spending 2004 Medicare Spending 2004 Medicare Spending $ % of Total $ Medication Events$155, %$53, % Total Falls$196, %$108, % Total Skin Events$268, %$131, % Nosocomial Infections $591, %$252, % TOTAL inpatient savings from 4 areas $1,212, %$545, % Potential savings as a % of all inpatient expenses $11.9 Million13.61%

Additional Cost of Care Declining by 2.2% Per Month SOURCE: APTIS, Inc.

Trend in Medical Malpractice Claims Total Claims by year SOURCE: APTIS, Inc.

Patient Safety Outcomes 16% Relative Reduction in Hospital Fall Rate 28% Relative Reduction in Hospital Medication Event Rate 0.2% Incidence of Skin Breakdown (0.4-38% National Incidence) 40% Relative Reduction in Additional Cost of Care over 30 Months for Adverse Events* 50% Relative Reduction in Additional Days of Stay over 30 Months for Adverse Events* * As Calculated by SafeCare Systems SIS – 400-bed facility

Data Source = SafeCare SIS 01/99 – 07/04 SOURCE: APTIS, Inc.

Medication Events Rate per 1,000 Adjusted Patient Days JanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJuneJulyAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJulAugSepOctNovDecJanFebMarAprMayJunJul Data Source = SafeCare SIS 01/99 – 07/04 SOURCE: APTIS, Inc.

Data Source = SafeCare SIS 01/99 – 07/04 SOURCE: APTIS, Inc.

SafeCare Safety Information System Key Benefits Identifies the safety opportunities Manages the organizations response Measures the effectiveness of QI initiatives Quantifies the cost savings