53 “NEVER EVENTS” - THE INCIDENCE AND COST IMPLICATIONS OF “PREVENTABLE” COMPLICATIONS IN AN ACADEMIC UROLOGY PRACTICE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes1 Apr 201153 “NEVER EVENTS” - THE INCIDENCE AND COST IMPLICATIONS OF “PREVENTABLE” COMPLICATIONS IN AN ACADEMIC UROLOGY PRACTICE Elias Hyams and Brian Matlaga Elias HyamsElias Hyams Baltimore, MD More articles by this author and Brian MatlagaBrian Matlaga Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2655AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2008, the Center for Medicare Services (CMS) enumerated a list of “preventable” adverse events and began restricting payments for associated costs. These so-called “never events” include certain unambiguous preventable errors like wrong site surgery and retained foreign bodies, but also certain medical and surgical complications that might result from non-modifiable risk factors (e.g. surgical site infection, deep venous thrombosis/pulmonary embolism). In this study, we investigated the incidence of current or proposed “never events” during a one year period in a tertiary level academic urology practice. Also we sought to quantify inpatient costs directly attributable to these events. METHODS We reviewed a prospectively maintained database of patient morbidity and mortality in the urology department of our tertiary care hospital during a 1 year period (July 2009-June 2010). Incidence of current and proposed “never events” were collated. Inpatient billing records for infection-related events were specifically reviewed, including readmissions within a 30 day period, and the additional costs incurred by each event were determined. Only costs that were unambiguously attributable to the event were included. RESULTS Table 1 demonstrates the incidence of various current and proposed “never events.” Infection-related events (catheter-associated urinary tract infection, surgical site infection, C. difficile infection, infected device) generated additional hospital charges of $168,428.28 (mean $7655.83 per patient; range $1.26–70,151.94). Event Overall Incidence(5305 cases) Adult Incidence(4032) Pediatric Incidence(1273) C. difficile infection (6) 0.11%(6) 0.12%(5) 0.08%(1) Surgical site infection (12) 0.23%(12) 0.17%(7) 0.39%(5) Catheter-associated UTI (8) 0.15%(8) 0.17%(7) 0.08%(1) Infected device (1) 0.02% (1) 0.03%(1) 0%(0) Hospital acquired pneumonia (4) 0.08%(4) 0.10%(4) 0%(0) Deep venous thrombosis/pulmonary embolism (17) 0.32%(17) 0.42%(17) 0%(0) Hip fracture (1) 0.02%(1) 0.03%(1) 0%(0) Anesthesia-related (3) 0.06%(3) 0.05%(2) 0.08%(1) Positioning-related (5) 0.09%(5) 0.12%(5) 0%(0) Narcotic overdose (2) 0.04%(2) 0%(0) 0.16%(2) CONCLUSIONS While “never events” are relatively rare in an academic urology practice, they can generate substantial cost burden if reimbursement is limited. For high risk patients, e.g. elderly bladder cancer patients with multiple comorbidities, it may be impossible to determine whether specific events are preventable even when best practices are followed. Furthermore, determining which costs are directly attributable to an event during a complex hospital course may not be routinely feasible. Health care policy that seeks to incentivize quality care must recognize these methodological issues and not provide a separate incentive to limit care to high risk patients. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e22-e23 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elias Hyams Baltimore, MD More articles by this author Brian Matlaga Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...