Economic evaluations of maintaining patient safety systems in teaching hospitals

Abstract

Objective

The aim of this study was to assess the status and the cost of hospital patient safety systems.

Methods

We conducted a national questionnaire survey of all the 1039 teaching hospitals in Japan. The study was constructed to evaluate the costs of the systems for patient safety focused on staff assignment, meetings and conferences, internal audit, staff education and training, incident reporting, infection surveillance, infectious disposal, management of medication use, clinical engineering, and patient counseling.

Results

The status to maintain patient safety systems might be at least as decent. The mean estimated total cost of systems for patient safety was US$ 20,449 (95% confidence interval [CI], 19,632–21,266) per 100 bed-months or US$ 8.52 (95% CI, 8.18–8.86) per inpatient-day. The ratio of costs to revenue was 1.68% (95% CI, 1.61–1.75). The annual necessary costs occurring in hospitals where the costs of patient safety were under the average level across all the 1032 teaching hospitals in Japan was US$ 259.7 million.

Conclusions

Our results show that hospital-wide activities for patient safety pose significant costs to hospitals and national healthcare systems. Our data may provide financial information for designing and improving patient safety systems.

Introduction

In spite of momentum gained by designing and requiring patient safety goals, such as from Committee on Quality Health Care in America [1] and from The Joint Commission [2], discussions of cost, imperative to assessing the feasibility and logistics of these goals, are still lacking. In response to the report by the Institute of Medicine (IOM) on medical errors in hospitals in the United States [3], stakeholders in healthcare have recommended actions to reduce the occurrence of preventable medical errors [4], the public has expressed support for a range of programs aimed at reducing medical errors [5], regulation authorities have exerted new efforts to reduce the incidence of medical errors [6], [7], [8], [9], [10], and researchers have accelerated patient safety researches and publications [11]. This phenomenon is similar to the state of patient safety systems in Japan. Although the importance of research that estimates costs of patient safety systems has been recognized in recent years [12], [13], few estimates have been conducted [14].

Studies that estimate the costs of implementing resources for patient safety in hospitals should include hospital-wide activities, because the most important strategy for improving patient safety is to develop systems that will reduce the probability of error and improve the probability of safety [1], [3], [15]. Whereas the necessity of a system approach has been emphasized, the cost issue has received scant attention. According to our preliminary cost study focused on hospital-wide activities for patient safety and infection control in seven teaching hospitals [16], an increase of an average of US$ 9.68 per patient-day was required to implement patient safety programs between 1999 and 2004. Since a system approach requires participation in patient safety programs by all healthcare staff with a high opportunity cost, healthcare organizations must expend considerable resources for a system approach of patient safety.

In addition, little to no attention has been paid to the issue of patient safety from the perspective of national healthcare delivery systems on a macroscale. In general, patients have few chances to select a hospital themselves. Even if free access to healthcare institutions is assured, such as in Japan, it is common for family doctors to judge institutions based on the patient's medical necessity, emergency, or relationship among institutions. Due to the difficulty of measuring safety [17], it is nearly impossible to select safer hospitals even when patients can choose institutions on their own. This leads hospital administrators to find little incentive to implement patient safety measures. Moreover, most of costs associated with adverse events in hospital fall on injured patients, their family and their health insures [10]. Therefore, policy-makers are required to develop safer healthcare delivery systems; wherever patients visit, they will receive safe medical care because all hospitals will have effective patient safety programs.

Considering these points, important economic issues arise. If all hospitals were to implement measures typical for patient safety among teaching hospitals, the degree of financial impact on the government would be essential information for policy-makers. While it remains difficult to evaluate the impact of patient safety programs [17], if all hospitals were to improve upon previously insufficient quantities of measures compared to current investment in safety, cumulative financial resources will be required at a national level. Hence, from the viewpoint of health policy-makers who need to assure a safe environment for the public, quantifying the necessary costs for widespread adoption is essential. Past estimates of the costs associated with activities for patient safety have had serious limitations; they either have not been hospital-wide or have mainly focused on material intervention [14].

To estimate the costs associated with hospital-wide systems for hospital-level patient safety measures (including infection control), we conducted a national questionnaire survey. We placed particular focus on three aims. First, we assessed the status of hospital patient safety systems in Japan's teaching hospitals. Second, according to the status of the systems, we estimated unit cost (e.g. per 100 bed-months, per inpatient-day, and ratio of cost to revenue) to maintain patient safety systems. Finally, based on the cost calculations, we estimated additional costs for providing patient safety resources at the average level for all the 1039 teaching hospitals in Japan.