Commentary: Signs of Safety Improvement in Pennsylvania's Healthcare Community
Those of us working in patient safety look to a variety of sources for evidence that the delivery of healthcare is becoming safer. One significant area of success in Pennsylvania is a substantial reduction in malpractice claims since the Medical Care Availability and Reduction of Error Act of 2002 (MCARE)—the Pennsylvania Patient Safety Authority’s authorizing legislation—was signed into law.
Since 2002, payouts from the state’s excess liability fund have dropped by 58%, and the number of claims has been cut by more than half (Figure 1).1 Some of this decline is attributed to MCARE’s tort reform provisions, such as the requirement for certificates of merit, a reduction of MCARE coverage limits, and the requirement in Act 127 of 2002 that malpractice actions be brought in the county where the cause of action occurred. However, these were structural changes that would have caused marked, one-time shifts in the malpractice environment, most evident in 2002 and 2003 as these provisions went into effect. Yet, claims and payouts have continued to decline since then, and this may represent healthcare facilities’ progress in improving patient safety.Figure 1. MCARE Payments and Claims (2000-10)
What makes these results even more significant is that they occurred during a time when malpractice claim costs were increasing in the United States as a whole (Figure 2). Between their 2004 peak and 2009, hospital professional liability loss costs per bed dropped by over 23% among hospitals in Pennsylvania. During the same period, hospitals nationally saw their loss costs per bed rise by about the same percentage.2Figure 2. Hospital Professional Liability Loss Cost per Bed, Indexed to 2002
While claims represent only one lens through which we examine how safely care is delivered, a 2010 report from the RAND Corporation established a strong link between patient safety and malpractice claims. The researchers used 20 patient safety indicators developed by the Agency for Healthcare Research and Quality to identify 365,000 adverse events in a database of California hospital discharge data from 2001 through 2005. They analyzed these data in combination with data on more than 27,000 claims from physician malpractice carriers covering more than 50% of non-self-insured physicians in the state. Analyzing the data by year at the county level, they found that a decrease of 10 adverse events in a given year correlated with a decrease of 3.7 malpractice claims and that three-fourths of the within-county variation in claims could be accounted for by changes in patient safety outcomes.3
Other encouraging signs of progress include the following:
- In this issue of the Pennsylvania Patient Safety Advisory, we provide an update on our progress in eliminating wrong-site surgery. In a previous issue we documented that while wrong-site surgery persists, since the Authority began collecting data in 2004, a greater proportion of cases have been wrong-side regional blocks, suggesting a reduction in severity, if not frequency.4
- Hospitals participating in a wrong-site surgery prevention collaborative sponsored by the Health Care Improvement Foundation achieved a 72% reduction in wrong-site surgeries through implementation of 11 action goals aimed at prevention.5 The Authority helped to monitor the program’s success by providing deidentified, aggregate data on the number of cases reported each quarter by participating hospitals, and the Authority’s clinical director, John R. Clarke, MD, FACS, served as faculty for the collaborative’s workshops.
- Pennsylvania hospitals have made significant strides in reducing the incidence of healthcare-associated infections (HAIs). For example, the catheter-related urinary tract infection rates in all unit types in Pennsylvania hospitals were lower than in comparable units nationally, ranging from 19% to 84%.6
- A report on HAIs from the U.S. Centers for Disease Control and Prevention found that Pennsylvania’s rate of central line associated bloodstream infections was nearly one-third lower than the national average.7
- A grassroots effort by Pennsylvania hospitals to implement the Authority’s guidance on the use of color-coded patient wristbands to communicate important clinical information has developed into a de facto standard endorsed by the American Hospital Association and adopted in approximately half of U.S. states.8
- An upcoming issue of the Advisory will feature the results of an Authority-sponsored collaborative in which participating hospitals substantially reduced errors in blood specimen labeling. The Authority is supporting other multifacility collaboratives on such topics as wrong-site surgery, patient falls, and surgical site infections that we hope will report positive results in the near future.
While we cannot yet claim that healthcare is as safe as it should be, it’s important to recognize and celebrate our successes, to hold the gains that we’ve made, and to encourage knowledge transfer to increase the diffusion of effective practices.
- Pennsylvania Office of the Governor. Pennsylvania sees significant improvements in medical malpractice climate [press release online]. 2010 Oct 5 [cited 2011 Jan 3]. Available from Internet: http://www.prnewswire.com/news-releases/governor-rendell-pennsylvania-sees-significant-improvements-in-medical-malpractice-climate-104352743.html.
- Johnson E. Hospital professional liability and physician liability 2009 benchmark analysis. Chicago: Aon Analytics; 2009.
- Greenberg MD, Haviland AM, Ashwood JS, et al. Is better patient safety associated with less malpractice activity? [online report]. 2010 [cited 2011 Jan 3]. Available from Internet: http://www.rand.org/pubs/technical_reports/2010/RAND_TR824.pdf.
- Quarterly update on the preventing wrong-site surgery project: digging deeper. Pa Patient Saf Advis [online] 2010 Mar [cited 2011 Jan 3]. Available from Internet: http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2010/Mar7(1)/Pages/26.aspx.
- Pelczarski KM, Braun PA, Young E. Hospitals collaborate to prevent wrong-site surgery. Patient Saf Qual Health 2010 Sep-Oct:20-6.
- Pennsylvania Department of Health. 2008 report: healthcare-associated infections (HAI) in Pennsylvania hospitals [online]. 2010 Feb 16 [cited 2011 Jan 3]. Available from Internet: http://www.portal.state.pa.us/portal/server.pt/directory/haip/123902?qid=76847912&rank=6#.
- Centers for Disease Control and Prevention. First state-specific healthcare-associated infections summary data report [online]. 2009 Jan-Jun [cited 2011 Jan 3]. Available from Internet: http://www.cdc.gov/hai/pdfs/stateplans/SIR_05_25_2010.pdf.
- American Hospital Association. Implementing standardized colors for patient alert wristbands [online]. Qual Advis 2008 Sep 4 [cited 2011 Jan 14]. Available from Internet: http://www.aha.org/aha/advisory/2008/080904-quality-adv.pdf.