Report: A Third of Rehab Patients Suffered Care-Related Harm

Rehabilitation hospitals are supposed to be a place where patients go to recover from a health condition. A recent government report however, indicates that sometimes, care received through these facilities can lead to additional harm. The Office of Inspector General of the U.S. Department of Health and Human Services sampled 417 Medicare patients in rehabilitation facilities, focusing on those not associated with a hospital. Nearly a third suffered harm related to their care. In many instances, the injuries they developed were clearly or likely preventable.

Patients admitted into a rehabilitation facility are usually presumed to be healthier than those in a hospital or nursing home. They are usually capable of undergoing the required three hours of physical and occupational therapy each day, five days a week. Rehab patients may be recovering from conditions such as a recent stroke, surgery or injury.

The IG report said that 29 percent of reviewed patients suffered some form of harm related to the care they received at a rehab facility. These included injuries such as a bedsore, medication error or infection. Doctors said half of the 158 incidents identified were clearly or likely preventable.

According to physicians who reviewed the Medicare cases for OIG, poor monitoring and failure to provide necessary care caused the harm. In 46 percent of cases, nearly half, patients were harmed by a medication error. These mistakes involved patients suffering bleeding from gastric ulcers due to blood thinners and loss of consciousness due to narcotic painkillers.

Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, commented that the high rate of medication errors is a chance for improvement.
“We know a lot about preventing medication errors,” he said, according to ProPublica.

In 40 percent of cases, oversights in monitoring caused injuries such as bedsores, constipation or falls. Lisa McGiffert, director of the Consumers Union Safe Patient Project who was not involved in the study, says these incidents rarely lead to death but they can lengthen a patient’s recovery time or cause permanent disability. “It is a domino effect for any person who has had an adverse event,” she said, according to ProPublica.

“This is the latest study over a long time period now that says we still have high rates of harm,” said
Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine, according to ProPublica. “We’re fooling ourselves if we say we have made improvement,” said Classen, who developed the analytic tool used in the study. “If the first rule of health care is ‘Do no harm,’ then we’re failing.”

“It’s important to acknowledge that harm can occur in any type of inpatient setting,” said rehabilitation hospital study team leader Amy Ashcraft, according to ProPublica. “This is one of the settings that’s most likely to be underestimated in terms of what type of harm can occur.” Previous studies have shown that care-related harm occurs in one-quarter of patients in hospitals and a third in skilled nursing facilities.

The inspector general is advising that Medicare and the Agency for Healthcare Research and Quality collaborate and create a list of adverse events occurring in rehabilitation facilities in order to reduce patient harm. The agencies both vowed to follow this recommendation.

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