What’s New in the Patient Safety World

September 2010


New Studies on the Cost of Complications



Our August 21, 2007 Patient Tip of the Week “Costly Complications About to Become Costlier” provided estimates of the costs to hospitals of some common potentially preventable complications. Our January 22, 2008 Patient Safety Tip of the Week “More on the Cost of Complications” provided further insights into such costs.


Now two new studies have looked at the cost of complications. The first (Shreve 2010), done for the Society of Actuaries, estimates the cost of medical errors in 2008 to have been $19.5 billion. Of this $17 billion was in direct medical costs and the rest in indirect costs.


That study was based on medical claims data and used ICD-9 codes to identify possible cases of medical error. It used assumptions based on prior studies to come up with the methodology. It assumed 7% of inpatients have some type of medical injury, resulting in 6.3 million medical injuries and, of these, 1.5 million are associated with medical errors. They then compared the costs against those of a cross-matched control sample. They note these estimates do not include things like malpractice settlements and pain and suffering and suspect these represent underestimates and should be looked at as a lower limit to the actual cost. The 5 categories with the highest measurable costs were decubitus ulcers, post-operative infections, medical complications of devices, implants or grafts, post-laminectomy syndrome, and hemorrhagic complications of procedures.


The second study (Lucado 2010) was an AHRQ HCUP study looking at the influence of hospital associated infections from 2000-2007, using a methodology that captured AHRQ Patient Safety Indicator PSI #7 and applying some risk adjustment for factors such as comorbidities. Comparing the cost of cases with such infections to those without infections, they found HAI’s were associated with 19.2 days longer lengths of stay and average costs of $43,000 more. The incidence of HAI’s peaked in 2004 and 2005 at 2.3 cases per 1000 admissions, then declined to 2.03 cases per 1000 in 2007. Though the incidence increased with age, the highest occurrence rate was in the age population 45-64 years old.


Note, however, that in our January 22, 2008 Patient Safety Tip of the Week “More on the Cost of Complications” we mentioned a study by Kilgore et al (Kilgore 2008) that pointed out an important confounding factor in most prior studies on cost of complications: the length of stay confounding variable. In many cases, excess LOS is due to the nosocomial infection. However, in others excess LOS may simply reflect severity of illness and indicate a patient who is also at risk for nosocomial infections. So they attempted to correct for confounding variables, particularly for LOS, and found the “attributable” costs (i.e. attributable to the infection) was considerably less than other methodologies would have shown.


Nevertheless, the 2 new studies do provide us with some reasonable estimates of the potential costs of a number of different iatrogenic occurrences.


This month’s Pennsylvania Patient Safety Advisory also has a timely article “Demonstrating How To Demonstrate Return On Investment For Infection Prevention And Control" that walks you through the steps to develop a business case for infection control programs and a link to a sample business plan.






Shreve J, Van Den Bos J, Gray T, et al for the Society of Actuaries. The Economic Measurement of Medical Errors. Milliman June 2010




Lucado J,  Paez K, Andrews R, Steiner C. Adult Hospital Stays with Infections Due to Medical Care, 2007. AHRQ. H-CUP Statistical Brief #94. August  2010




Kilgore ML, Ghosh K, Beavers,C M, Wong DY, Hymel PA, Brossette SE. The Costs of Nosocomial Infections. Medical Care 2008; 46(1):101-104




Pennsylvania Patient Safety Authority. Demonstrating Return on Investment for Infection Prevention and Control. Pa Patient Saf Advis 2010; 7(3): 102-7















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