Thursday, July 21, 2016 HHS: 29% of Rehab Hospital Patients Experience Adverse Events, Temporary Harm During Stays Close to 1 in 3 Medicare beneficiaries in independently-run rehabilitation hospitals experience adverse or temporary harm events during their stay—and nearly half of those events are preventable, according to a new report from the Department of Health and Human Services (HHS) inspector general. The report, part of a series that also analyzed adverse events in acute care hospitals (ACHs) and skilled nursing facilities (SNFs), involved reviews of a "representative sample" of 417 Medicare beneficiaries who were discharged from independently-run (as opposed to hospital-based) rehab hospitals in March 2012. Nurse screeners identified cases that indicated adverse events, and a panel of physicians evaluated the events to rate severity, as well as to assess the possibility that the event could have been prevented. Here's what they found: Overall, the rehab hospitals' rates were in line with ACHs and SNFs. Earlier HHS studies found harm rates of 27% for ACHs and 33% for SNFs. The 29% harm rate for the rehabilitation hospitals isn't much different. 46% of the events were "clearly" or "likely" preventable, 51% weren't, and the remaining 3% were unclear. The 46% rate was further broken down according to whether the event was "likely" preventable (38% of all cases) or "clearly" preventable (8% of all cases). The 51% of "not preventable" events were described as ones in which "harm could not have been avoided given the complexity of the patient's condition or care required." Authors of the report write that when it came to the preventable events, "reviewers frequently cited as factors the provision of appropriate treatment in a substandard way and failure to adequately monitor a patient's progress" as elements leading to the event. Out of 158 events, 112 were classified as "temporary harm events," with the rest described as more serious "adverse events" that resulted in longer stays, transfers to ACHs, permanent harm, interventions to sustain the patient's life, or death. Authors estimate that temporary harm events make up about 18% of all events. Less than 1% of patients experience an event that leads to death, while 1.7% experience a "cascade event"—a series of multiple harm events related to a single cause. Falls were associated with 4% of all events. Of the 158 adverse events studied, 6 were related to falls. Pressure ulcers were cited in 8%, venous thromboembolism, deep vein thrombosis, or pulmonary embolism in 2%, and edema/volume overload in 1%. Nearly 1 in 4 Medicare patients who experienced an event were transferred to an ACH. That ratio includes both patients admitted as inpatients and patients who had outpatient emergency department visits only. Authors estimate that those ACH admissions and visits cost Medicare about $92 million annually. As for what to do about lowering the rates of harm, authors recommend that the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS) include rehabilitation hospitals among its targets for education and training. Additionally, the report calls for AHRQ and CMS to collaborate on the creation of a list of potential events that would "go beyond conventional postacute care issues (eg, falls, pressure ulcers) and include a comprehensive range of possible patient harm, emphasizing the unique case mix in rehab hospitals and the rehabilitation needs of affected patients." According to the report, CMS and AHRQ have agreed with the recommendations. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.