The Impact of Quality Training to Improve Patient Outcomes, Reduce Cost of Medical Error

Synopsis

The cost of medical error and malpractice payouts on our healthcare system is significant. Lives are lost or permanently altered; valuable resources are allocated to mitigating mistakes rather than preventing them. Healthcare professionals, administrators, and policymakers can work together to change the current healthcare climate and improve patient safety and outcomes. Current research demonstrates that quality improvement training saves resources, reduces error, and improves patient outcomes. A proactive approach of investing in programs and education focused on elevating our level of patient care can lead to solutions that prevent medical error and protect our patients, providers, hospitals, and communities.

The Cost of Medical Error

In regards to medical error in the United States, the statistics are significant:

• Medical error is the 3rd highest cause of death in the U.S.¹
• 10 percent of all U.S. deaths are due to medical error.¹
• Medical errors in hospitals and clinics result in approximately 100,000 people dying each year.²
• 400,000 hospitalized patients each year experience some type of preventable harm.²
• In high-income countries, 1 in 10 patients are harmed during medical treatment, and 7% acquire healthcare-associated infections during hospital stays.³

The cost of these errors to our communities and the lives of those impacted are immeasurable. For hospital administrators and public policy makers, the economic impact of medical errors is easier to quantify, though insufficient in scope.

According to recent research, medical errors cost approximately $20 billion per year in the U.S.;² those estimates rise to $1 trillion annually when quality-adjusted life years are taken into account.⁴ These numbers underestimate the full economic impact of medical errors in that they do not factor in the time and resources lost due to poor or ineffective healthcare. As an example, healthcare-related infections specifically add nearly $35 billion to the annual cost of healthcare in the U.S.³ In 2010, the World Health Organization (WHO) estimated that 20–40% of all health sector resources are wasted.⁵ In 2018, the WHO elaborated on these findings, revealing that 15% of hospital expenditure in high-income countries is due to mistakes (which equated to $178.8 billion in the U.S. in 2018) and that 20% of health resources are used in ways that don’t make improvements.³ 

When put into context, each of these numbers represents only a portion of the costs our communities assume due to medical error. 

Increases in Large Insurance Claims

Since 2012, annual medical malpractice payouts have followed an upward trend, surpassing $4 billion in 2018.⁶ The average payout per claim is similarly rising,⁶ with large insurance claims of over $5 million increasing over the past two decades.⁷

Valentina Minetti, U.S. hospital focus group leader at the Beazley Group, said about these trends, “The average paid claim with indemnity closing in 2018 was 6% higher than in 2017. While that is only a single-digit increase from year to year, the cumulative effect of similar rises has taken the average paid claim from $400,000 in 2009 to almost $600,000 in 2018. That means paid claims are 50% higher than they were 9 years ago.”⁸ 

In less than a decade, paid malpractice claims have climbed by 50%. Of those claims, 86.9% included the death or permanent injury of patients.⁶

Finding Solutions

In Medical Error Prevention, Thomas L. Rodziewicz and John E. Hipskind identify one of the root causes of medical error as “deficiencies in education, training, orientation, and experience.”² The reverse is also true. Education and training, especially those focused on quality improvement, have been repeatedly shown to improve patient outcomes and reduce medical costs.^2,3,9 As Rodziewicz and Hipskind succinctly note, “Teamwork, education, and training through structured initiatives are the most effective mechanism to improve patient safety.”²

Across specialties, quality training has been shown to improve patient outcomes. The study “In situ, multidisciplinary, simulation-based teamwork training improves early trauma care” found that simulation-based teamwork training resulted in significant improvements in early trauma care, including the speed and completeness of resuscitation.¹⁰ After a brief, 4-hour training, near-perfect task completion increased by 76%, and the overall resuscitation time decreased by 16%.¹⁰ Another study in BJOG: An International Journal of Obstetrics and Gynaecology found that obstetrics emergency training reduced neonatal hypoxic-ischaemic encephalopathy in infants by over 50%.¹¹

Another example, this one from the Annals of Emergency Medicine, found that scenario-based training and real-time audiovisual feedback resulted in “improved CPR quality, an increase in survival, and favorable functional outcomes after out-of-hospital cardiac arrest.”¹²The study noted that after training, every aspect of CPR delivery improved and that witnessed arrests/shockable rhythms survival improved by 29.2%, more than doubling from the initial 26.3% to 55.6%.¹²

Proper training can also impact medical malpractice litigation. One study published in Health Services Research examined how training and education designed to improve perinatal care impacted malpractice claims. After the new training was implemented, the rate of claims paid dropped by 37%, and the total amount of losses dropped by 56%, from $2,170,000 per 10,000 deliveries to $950,000 per 10,000 deliveries.¹³ The study also notes, “For perinatal claims, the average number of claims paid per hospital, the total average amount of losses paid per hospital, and the average amount of indemnity payments per hospital dropped precipitously (43.9 percent, 77.6 percent, and 84.6 percent, respectively) compared to no change in the overall claims activity in the same hospitals.”¹³

These examples demonstrate the impact of quality training on healthcare outcomes.

As the World Health Organization notes, “Integrating the principles of quality and quality improvement into pre-service and in-service education and training curricula and programs is vital in building a competent workforce that is capable of delivering high-quality health services.”³

Current statistics surrounding the cost of medical error are significant; however, the ways training and education can improve patient outcomes and lower healthcare costs are equally as impactful. Sources

Sources

1. Makary M, Daniel M. Medical error—the third leading cause of death in the US. BMJ. 2016; 353:i2139. https://doi.org/10.1136/bmj.i2139. 
2. Rodziewicz TL, Hipskind JE. Medical Error Prevention. Updated 2020 Feb 5. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK499956/. 
3. Delivering quality health services: a global imperative for universal health coverage. Geneva: World Health Organization, Organisation for Economic Co-operation and Development, and The World Bank; 2018.
4. Andel C, Davidow SL, Hollander M, Moreno DA. The economics of health care quality and medical errors. J Health Care Finance. 2012;39(1):39–50.
5. World health report 2010. Health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.
6. 2019 medical malpractice payout report. National Practitioner Data Bank, LeverageRx. 2020. https://www.leveragerx.com/malpractice-insurance/2019-medical-malpractice-report/. 
7. Jones V, Minetti V, McCullaugh M, Page J. Understanding changes in the medical malpractice insurance market. 2019. Aon/ASHRM Hospital and Physician Professional Liability Benchmark Analysis. https://ae.beazley.com/pdf/2019_AonASHRM_HPL_Benchmark_Report.pdf.
8. Medical malpractice becoming more costly. Managed Healthcare Life Sciences. 2019 Dec 1. https://www.managedhealthcareexecutive.com/news/medical-malpractice-becoming-more-costly.
9. Lincoln EW, Reed-Schrader E, Jarvis JL. EMS, Quality Improvement Programs. Updated 2019 Jul 28. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK536982/. 
10. Steinemann S, Berg B, Skinner A, DiTulio A, Anzelon K, Terad K, Oliver C, Chih Ho H, Spec C. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. Journal of Surgical Education. 2011: 68; 6.
11. Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, Whitelaw A. Does training in obstetric emergencies improve neonatal outcome? BJOG: An International Journal of Obstetrics & Gynaecology. 2006. 113: 177-182. doi:10.1111/j.1471-0528.2006.00800.x. 
12. Bobrow BJ, Vadeboncoeur TF, Stolz U, Silver AE, Tobin JM, Crawford SA, Mason TK, Schirmer J, Smith GA, Spaite DW. The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest. Ann Emerg Med. 2013;62:47–56. doi: 10.1016/j.annemergmed.2012.12.020.
13. Riley W, Meredith LW, Price R, Miller KK, Begun JW, McCullough M, Davis S. Decreasing malpractice claims by reducing preventable perinatal harm. Health Serv Res. 2016; 51(Suppl 3):2453–71.