HOME PAGE: Author Site, MARY REGINA’S NURSING HOME
Long-term-care hospitals (LTCHs) are inpatient hospitals that treat patients who are very ill—often with several acute and/or chronic conditions—and require care for an extended period. LTCHs provide continued, acute-level care for patients following their stays in traditional acute-care hospitals.
The HHS Office of Inspector General (OIG) found that 21 percent of Medicare patients in LTCHs experienced adverse events, which are particularly serious instances of patient harm resulting from medical care, according to a November 2018 OIG report.
The four categories of adverse events include outcomes such as prolonging a patient’s LTCH stay or necessitating transfer to another facility; requiring life-saving intervention; resulting in permanent harm; and contributing to death. (Five percent of Medicare patients in LTCHs experienced adverse events that contributed to or resulted in their deaths.)
An additional 25 percent of patients experienced temporary harm events, which are patient harm that required medical intervention but did not cause lasting harm.
The overall percentage of patients in LTCHs who experienced either type of harm (adverse events or temporary harm events) is 46 percent, higher than OIG found in hospitals (27 percent), skilled nursing facilities (33 percent), and rehabilitation hospitals (29 percent).
Patient stays in LTCHs present more opportunities for harm events because the stays are longer, but the number of harm events per patient day was similar between LTCHs and other post-acute-care settings and lower than in non-LTCH acute-care hospitals.
Over half of these adverse events and temporary harm events (54 percent of harm events) were clearly or likely preventable. Preventable harm events were often related to substandard care (58 percent) and medical errors (34 percent).
Forty-five percent of harm events were found to be clearly or likely not preventable, often because the patients were highly susceptible to harm due to other health conditions or poor overall health.
In response to prior OIG work, the Centers for Medicare & Medicaid Services (CMS) and Agency for Healthcare Research and Quality (AHRQ) took important steps to raise awareness of adverse events and temporary harm events and to reduce harm in several inpatient settings. OIG said AHRQ and CMS should tailor their ongoing efforts to improve patient safety to address the specific needs of LTCHs. OIG recommended that AHRQ and CMS collaborate to create and disseminate a list of potential harm events in LTCHs and that CMS include information about patient harm in its outreach to LTCHs. CMS and AHRQ concurred with the recommendations.
The entire report is available at https://oig.hhs.gov/oei/reports/oei-06-14-00530.pdf