Adverse Events in Rehabilitation Hospitals: National Incidence Among Medicare Beneficiaries

WHY WE DID THIS STUDY

This report is part of a series on adverse events in health care settings, defined as harm resulting from medical care. Previous OIG work identified harm rates of about 30 percent in both acute-care hospitals and skilled nursing facilities (SNF), with an attendant toll on patient health and taxpayers' costs, the latter amounting to billions of dollars annually. This report extends our work by evaluating care provided in rehabilitation (rehab) hospitals. Rehab hospitals are post-acute providers that specialize in intensive rehabilitative care for patients recovering from illness, injury, or surgery. While in recent years stakeholders have paid considerable attention to patient safety in acute-care hospitals and increasingly in SNFs, less is known about adverse events in other health care settings. An increased understanding of adverse events that occur in this unique setting would better equip health care providers and other stakeholders in taking actions to improve the safety of patient care in rehab hospitals.

HOW WE DID THIS STUDY

We reviewed medical records to estimate the national incidence rate, preventability, and costs of adverse events in rehab hospitals. We reviewed a nationally representative sample of 417 Medicare beneficiaries discharged from rehab hospitals in March 2012.

WHAT WE FOUND

An estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehab hospital stays, resulting in temporary harm; prolonged stays or transfers to other hospitals; permanent harm; life-sustaining intervention; or death. This harm rate is in line with what we found in hospitals (27 percent) and in SNFs (33 percent). Physician reviewers determined that 46 percent of these adverse and temporary harm events were clearly or likely preventable. Physicians attributed much of the preventable harm to substandard treatment, inadequate patient monitoring, and failure to provide needed treatment. Nearly one-quarter of the patients who experienced adverse or temporary harm events were transferred to an acute-care hospital for treatment, with an estimated cost to Medicare of at least $7.7 million in one month, or at least $92 million in one year, assuming a constant rate of hospitalization throughout the year.

WHAT WE RECOMMEND

The incidence of adverse events in rehab hospitals is similar to that in acute-care hospitals and SNFs, as reflected in previous OIG findings, confirming the need and opportunity to significantly reduce the incidence of adverse events across health care settings. We recommend that AHRQ and CMS raise awareness of patient safety issues in rehab hospitals and seek to reduce patient harm. This effort should include: (1) collaboration to create and disseminate a list of potential adverse events that occur in rehab hospitals and (2) the addition of information about potential adverse events in quality guidance to rehab hospitals. CMS and AHRQ concurred with our recommendations.