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PSNet: Patient Safety Network
Journal Article
Study

Impact of inpatient harms on hospital finances and patient clinical outcomes.

Adler L, Yi D, Li M, et al. Journal of patient safety. 2018;14:67-73.

A 2013 study showed hospitals actually profit when patients experience surgical complications, calling into question the business case for patient safety. This large multistate study used the Institute for Healthcare Improvement's global trigger tool to examine how all-cause inpatient harms affect hospital finances and clinical outcomes. Approximately 13% of inpatients experienced temporary harm and 12% experienced harm. This study relied on complicated cost accounting and statistical modeling, ultimately using three different financial models, including a novel approach that accounts for various diagnosis-related groups, to analyze the results. Patients who experienced harm had increased total costs, variable costs, and length of stay. Also, harms were associated with a lower contribution margin—an indicator of a hospital's profitability—suggesting harms result in negative financial outcomes for hospitals. As payment models increasingly shift toward paying for value rather than volume, the negative financial effects of inpatient harms are likely to be heightened.