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Government Report Shows a Third of Patients in Rehab Hospitals Suffer Harm

Aug 12, 2016

A report released by the Office of Inspector General of the U.S. Department of Health and Human Services found that nearly a third of patients in rehabilitation hospitals suffered harm, which was preventable in many cases. Rehabilitation hospitals are facilities that patients go to in order to recover their health. Common examples may be patients that suffered a recent stroke, surgery or recent injury. The report, however, suggests that going to these facilities may present additional risks.

The report, titled "Adverse Events in Rehabilitation Hospitals: National Incidence Among Medicare Beneficiaries", found that 29 percent of patients in rehab facilities suffered some type of harm as a result of care they received, such as a bedsore, medication error or infection. Doctors sampled 417 Medicare patients from various rehab hospitals. They identified 158 incidents, half of which were clearly or likely preventable.

Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine, developed the analytic tool used in the study. "This is the latest study over a long time period now that says we still have high rates of harm," he said, according to ProPublica. "We're fooling ourselves if we say we have made improvement," Classen said. "If the first rule of health care is 'Do no harm,' then we're failing."

The report focused on rehabilitation facilities not associated with hospitals. Patients admitted to these facilities are usually required to undergo a minimum of three hours of physical and occupational therapy each day, five days a week. It is generally expected that these patients are healthier than those in a typical hospital or nursing home.

"It's important to acknowledge that harm can occur in any type of inpatient setting," said rehabilitation hospital study team leader Amy Ashcraft, according to ProPublica. "This is one of the settings that's most likely to be underestimated in terms of what type of harm can occur." Previous studies have shown that care-related harm occurs in one-quarter of patients in hospitals and a third in skilled nursing facilities.

Harm was caused by inadequate care, including poor monitoring and failure to provide necessary care, according to physicians who reviewed the cases for the OIG. Medication errors accounted for 46 percent of cases. These incidents caused patients to suffer bleeding from gastric ulcers due to blood thinners and loss of consciousness due to narcotic painkillers.

According to Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, the high rate of medication errors indicates that much can be done to improve care. "We know a lot about preventing medication errors," he said, according to ProPublica.

Inadequate monitoring caused harm in 40 percent of cases, leading to bedsores, constipation or falls. Lisa McGiffert, director of the Consumers Union Safe Patient Project, says these incidents can lengthen a patient's recovery time or cause permanent disability even if they rarely cause death. "It is a domino effect for any person who has had an adverse event," she said, according to ProPublica. McGiffert was not involved in the study.

In light of these findings, the inspector general is advising that Medicare and the Agency for Healthcare Research and Quality team up to lower the rate of patient harm. IG recommended that the agencies create a list of adverse events occurring in rehabilitation facilities. Both agencies have agreed.

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