Third of US patients discharged to nursing homes are harmed during their stay, report says

BMJ 2014; 348 doi: (Published 10 March 2014) Cite this as: BMJ 2014;348:g2049
  1. Michael McCarthy
  1. 1Seattle

A third of Medicare patients who are discharged to a skilled nursing facility for post-acute care are harmed during their stay at the nursing home, says a new report.1

In the study by the Office of Inspector General at the US Department of Health and Human Services, investigators reviewed the records of 653 randomly selected Medicare beneficiaries whose stay at a skilled nursing facility had lasted a maximum of 35 days and had ended in August 2011.

Most (70%) of the patients had been hospitalized for medical treatment, and septicemia or urinary tract infections were the most frequent reasons for their admission. Thirty per cent had been hospitalized for surgical care, most often for hip or knee joint replacement.

While in the nursing home 22% of patients experienced harm that was serious enough to prolong their stay, cause them to be transferred to another facility or hospital, require life sustaining care, or result in permanent harm or death, the study found.

Another 11% experienced adverse events that required medical intervention but no lasting harm: 43% of these cases related to medicines, such as hypoglycemic episodes, delirium, and falls associated with medicines; 40% related to the care received, such as the development of pressure ulcers, and 17% related to infections, such as catheter associated urinary tract infections.

Most (59%) of the adverse events were considered preventable by physician reviewers, including 66% of the medication events, 57% of the resident care events, and 52% of the infections. Among the preventable events 37% involved inadequate monitoring and 25% involved failure to provide necessary treatments.

“Because more than half of the adverse events that we identified were preventable, our study confirms the need and opportunity for [skilled nursing facilities] to significantly reduce the incidence of events,” the investigators concluded.

To help the facilities do this, the investigators recommended that the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services create a list of threats to nursing home residents, to help staff identify and deal with common causes of harm and to instruct nursing home inspectors to review facility practices to identify and reduce threats to patients’ safety.


Cite this as: BMJ 2014;348:g2049