More action needed on adverse events in nursing homes, outpatient settings, expert tells Senators

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Subcommittee Chairman Bernard Sanders (I-VT)
Subcommittee Chairman Bernard Sanders (I-VT)

Nursing homes and other non-hospital providers largely have been overlooked in efforts to improve patient safety, and this needs to change, an expert told a Senate panel Thursday.

A widely publicized 1999 government report drew attention to the high rate of preventable errors in hospitals, and this mobilized lawmakers, providers and consumers to focus on the issue. But today, “little is known” about the “distinct safety issues” in nursing homes and other non-hospital settings, said Tejal Gandhi, M.D., MPH, president of the National Patient Safety Foundation and a professor at Harvard Medical School. Gandhi made her remarks before a subcommittee of the Senate Committee on Health, Education, Labor & Pension.

“We need better data in all of these settings to understand the risks and opportunities for improvement,” she said.

Other witnesses also emphasized the need for data related to quality measures, but some cautioned that reporting requirements already have become burdensome for providers. Focusing on outcome measures rather than process measures — which puts pressure on providers to document how they achieve results — could be a smart approach, said Lisa McGiffert, director of the Safe Patient Project, Consumers Union in Texas.

While quality measures need to be narrowed, according to Gandhi, she also said reducing the focus to “four or five” quality measures means other important areas get neglected. Implementing large-scale initiatives to change infrastructure, processes and culture is crucial to improving patient safety across the board, she emphasized. For example, an organization's culture should not discourage people from speaking up if they see an error.

Creating incentives around these improvements is crucial because “just measuring” isn't enough, Gandhi said.

Other panelists also said that adjusting payment policies to encourage and reward quality improvement is one of the most powerful tools Congress has for improving healthcare safety. Boosting the number of registered nurses giving bedside care and increasing the peer-to-peer review among similar providers were other ideas proposed by witnesses.

Subcommittee Chairman Bernard Sanders (I-VT) opened the hearing by noting that preventable medical errors is the third most common cause of death in the United States, according to Centers for Disease Control and Prevention figures.

About 22% of Medicare beneficiaries experienced an adverse event in a skilled nursing facility during a post-hospitalization stay in 2011, according to a government report released in March.

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