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Wednesday, January 02, 2008 12:00 PM

Newscast: Lead Story - The National Hospital Bill May Reach $1 Trillion in 2008

(opening music)

Rand: This is Healthcare 411 for the week of January 2, 2008

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Debra: I’m Debra James

Rand: And I’m Rand Gardner

Debra: Coming up:

Rand: Why the national hospital bill may reach one trillion dollars in 2008.

Debra: Plus, we’ve got ten patient safety tips for hospitals.

Rand: And steps consumers can also take to avoid medical errors.

Debra: More after this message from AHRQ.


[Begin PSA: Questions are the Answer]

Narrator: Medical mistakes claim tens of thousands of lives every year. The health care community is working on it, but you can help. When you communicate with your doctor, when you ask more questions, you reduce your risk of suffering a medical mistake. Doctors can’t answer if you don’t ask. Help reduce your risk. Questions are the answer. Learn the 10 questions you must ask. Visit www.ahrq.gov. This message brought to you by the U.S. Department of Health and Human Services, The Agency for Healthcare Research and Quality, and the Ad Council.

[End PSA]


Rand: Now the numbers.


Rand: The latest AHRQ data shows the amount U.S. hospitals billed over the last decade has nearly doubled. Hospital bills rose about 90 percent - from 462 billion in 1997 to 873 billion in 2005. And at this rate, researchers predict the national hospital bill may reach one trillion dollars in 2008. But who’s paying? Historically, the main payer towards our national hospital bill has been Medicare, the nation’s largest health insurance program that provides coverage for the elderly and disabled. While Medicare paid 411 billion dollars, private insurance agencies paid 272 billion. The government’s insurer for low-income individuals and families, Medicaid, also paid 124 billion. Experts calculate the rising costs of the national hospital bill were due to a variety of medical treatments. But a bulk of the bill about one fifth went to treating heart-related issues as well as pregnancy, childbirth and newborn infant care.

Debra: Patient safety is a subject AHRQ knows well, having funded more than 100 patient safety studies in the last six years. Based on research, AHRQ developed a set of evidence-based steps that hospitals can take to help prevent adverse events and medical errors. Today we’re talking with AHRQ Director Dr. Carolyn Clancy about AHRQ’s 10 Patient Safety Tips for Hospitals expert advice for hospitals looking to improve safety. Dr. Clancy, welcome.

Dr. Clancy: Thank you.

Debra: Dr. Clancy, how did AHRQ compile this advice for hospitals

Dr. Clancy: AHRQ reviewed the evidence that our patient safety researchers developed as part of the Agency’s initial $150 million investment into how to make health care safer. We know that medical errors can occur at many points in the health care system, particularly in hospitals. These ten tips for hospitals resulted from findings of the more than hundred studies supported by the Agency since 2001.

Debra: So, if a hospital is trying to improve its patient safety, where should it start?

Dr. Clancy: A great place to start is with its staff conduct a survey. AHRQ’s top ten list includes a link to a patient safety culture survey to help you assess where you’re doing well and where you have room for improvement.

Debra: What are some general areas most health care environments can improve?

Dr. Clancy: Through our research, AHRQ has found there’s a significant need to address medical errors caused by over-fatigued staff. Hospitals should minimize shifts of more than sixteen consecutive hours by residents, interns and nurses. This is more than a quality of life issue. One study found the rate of serious medical errors by first year interns in the ICU dropped by 36 percent when they eliminated thirty hour in a row work shifts. Motor vehicle accidents and needle stick injuries by sleep-deprived interns also decreased when staff worked shorter shifts.

Debra: Are there any specific medical procedures for which AHRQ offered patient safety tips?

Dr. Clancy: We did address the issue of how to insert chest tubes safely using universal protocol from the joint commission. We also remind clinicians that AHRQ offers a free eleven-minute training DVD that includes video excerpts of fifty actual chest tube insertion procedures. This has been wildly popular at medical meetings.

Debra: Does the list also include any suggestions for implementing new technologies that can improve patient safety?

Dr. Clancy: Technology can help by assisting staff with their safety practices. For instance, one technology is the use of computer based reminders. Our research has found that catheter removal after 72 hours reduces the risk of urinary tract infection, so a computer based reminder can help alert clinicians to remove catheters.

Debra: Was the list developed for particular groups in hospitals?

Dr. Clancy: There’s value here for all staff safety educators, charge nurses, program directors, administrators and everyone else at the hospital because patient safety is everyone’s job. It’s a team sport.

Debra: All the tools mentioned by Dr. Clancy can be ordered or are linked from the full list of AHRQ’s 10 Patient Safety Tips for Hospitals online at ahrq.gov/qual/10tips.pdf. And all of AHRQ’s patient safety research can be found at ahrq.gov.

Rand: Up next, we continue our conversation with Dr. Clancy with tips for Navigating the Healthcare System


Rand: Medical errors are one of the nation’s leading causes of death and injury. A report by the Institute of Medicine estimates that up to 98,000 people die in U.S. hospitals each year from medical errors. While government agencies and health care providers work together to make the health care system safer, in this segment on Navigating the Healthcare System, Dr. Clancy talks about the steps patients can take to help avoid medical errors. Dr. Clancy, help our listeners understand the full spectrum of what we are talking about when we discuss medical errors.

Dr. Clancy: Medical errors happen when something that was planned as a part of medical care doesn’t work out, or when the wrong plan was used in the first place. When most people think of medical errors, they think about a patient getting the wrong medication or an operation on the wrong part of the body. However, there are many other types of medical errors: for example when a patient’s test results are misinterpreted. Another example could be a patient who is given the wrong type of blood. Or a really simple example is when a doctor orders low-salt meals for a patient in a hospital, but that patient is given regular meals instead. Also, it’s important to know that medical errors don’t just happen in hospitals. They can happen in other health care settings like clinics, pharmacies or nursing homes.

Rand: It sounds like some of these issues are out of the patient’s control. Is there anything a patient can do to help decrease his risks?

Dr. Clancy: Absolutely! There are five important tips that all patients should follow. The first is ask questions if you have doubts or concerns, and make sure you understand the answers. The second is to keep and bring a list of all the medicines you take, including over-the-counter medicines, vitamins, supplements and so forth. The third tip is to get the results of any test or procedure that’s done. The fourth is to talk to your doctor about which hospital is best for your health needs if you need to go to the hospital. And the fifth and final tip is to make sure you understand what will happen if you need surgery or have another medical procedure done.

Rand: So, what’s the bottom line for patients when they go to a doctor’s office or any other health care setting?

Dr. Clancy: The single most important way a patient can help to prevent errors is to be an active member of his or her health care team. That means taking part in the decision-making process with your doctor and communicating with your health care team.

Rand: Dr. Clancy, thanks for joining us.

Dr. Clancy: You’re welcome.

Rand: AHRQ’s "5 Steps to Safer Health Care" patient fact sheet is available online at ahrq.gov/consumer/5steps.htm.


Debra: That’s it for this week. For more information on these and other health-related stories and topics go to www.ahrq.gov.

Rand: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For I’m Debra James, I’m Rand Gardner. Please join us for the next edition of Healthcare 411.

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