Big Business Moves to Cut Medical Errors in Hospitals

From the WebMD Archives

Nov. 15, 2000 (Washington) -- The crusade to reduce preventable medical errors has been taken up by big business. More than 60 large companies and other purchasers that provide health coverage for more than 20 million Americans announced an ambitious campaign to encourage hospitals to take steps to reduce their medical errors.

The purchasers, who call themselves the "Leapfrog Group," include corporate giants IBM, Xerox, and GM. Since the group accounts for more than $40 billion in annual health spending, they want to improve care for their employees by rewarding hospitals that take specific steps to create a safer health care system. The Leapfrog Group firms are members of the Business Roundtable, a Washington consortium of Fortune 500 companies.

In a landmark report released late in 1998, the Institute of Medicine estimated that as many as 98,000 Americans die each year from preventable medical errors. Congress subsequently held hearings on the problem, and legislation was proposed, but nothing has gone anywhere. Hospitals and doctors have vigorously protested measures that would have required mandatory reporting of their medical mistakes.

In its recommendations, the Leapfrog Group advises hospitals to require physicians to order medication through computers linked to software designed to prevent prescribing errors. The group also suggests referring patients needing complex medical procedures to medical institutions that have higher-quality outcomes from doing large volumes of those services and requiring that intensive care units (ICUs) be staffed by physicians with credentials in emergency medicine.

Though the prescription software is costly, it may prevent overdoses, eliminate errors from doctors' illegible handwriting, and block doctors from prescribing a medication the patient is allergic to or one that might adversely interact with another drug.

Lewis Campbell, CEO of Textron, a Leapfrog member, said, "We feel confident in our ability to make a difference by harnessing and leveraging our health care purchasing power. It's a straightforward business approach to tackling a complex problem."

The Leapfrog initiative would not punish hospitals that failed to meet the standards, but would highlight those institutions that did meet them and encourage consumers to choose them for their health care.

According to Leapfrog estimates released Wednesday, if all the nation's nonrural hospitals took up the three initiatives, 58,000 deaths would be prevented each year, as would 522,000 medication errors. But right now, the group estimates that less than 2% of hospitals use computerized physician medication orders and that only 15% of patients go to ICUs that meet its physician staffing standard.

Hospitals indicate they aren't on the fast track to taking up the Leapfrog recommendations. Anne Berdahl, senior associate director of health policy at the American Hospital Association (AHA), tells WebMD that the standards hold "some potential promise" but are still relatively new. For example, computerized physician drug entry systems are still evolving, she said, with no "off-the-shelf" software yet available for hospitals. "It's complicated. We think that hospitals should make their own decisions."

The AHA on Wednesday put out a report on the computer systems that claimed, "Studies demonstrating improvements in patient outcome are limited, as are studies of the costs and success factors related to [using these systems]."

The Leapfrog Group also defended its use of positive public relations for hospitals that comply with its standards, rather than the "shtick" of lower payment rates or no contracts for hospitals that fail to meet its measure. Bruce Bradley, director of managed care plans at GM, said, "[Hospitals and their health professionals] are not people that need a shtick. These are good people."

The shtick may appear, however, in the future. Jeffrey Kang, MD, the top quality official of the Health Care Financing Administration (HCFA), which runs Medicare, tells WebMD that he supports the Leapfrog Group's initiative. "I think the evidence is there. It's a good start -- they're taking a market-based approach." But he says, "There is an outstanding question that HCFA will be attempting to wrestle with -- whether you actually make that a regulatory requirement. That's something that we're going to be internally debating."


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