Estimating the hospital costs of preventable inpatient harms

Potentially preventable hospital inpatient medical harms—injuries to patients that occur while hospitalized—result in emotional and physical costs to patients and their caregivers, and financial costs to the health system. Examples of inpatient harms include surgical site infections (SSI), pressure ulcers, or falls-related injuries not present when the patient was admitted to the hospital.

This study estimates the additional hospital costs associated with specific inpatient harms. We estimated costs during the index admission that would not have occurred if the harm had not taken place, as well as the increased chance of a readmission within 90 days (and the costs associated with those readmissions). We used 2009–2011 data from 12 states from the Agency for Healthcare Research and Quality’s (AHRQ’s) Healthcare Cost and Utilization Project’s State Inpatient Databases (HCUP SID). We detected medical harms using the Patient Safety Indicators (PSIs) developed by AHRQ as well as the Centers for Medicare & Medicaid Services (CMS) HAC indicators. Our analysis also incorporated POA indicator data signifying whether the diagnosis was present on admission.

Our findings show substantial range in the additional hospital costs attributed to inpatient harms. The most costly harms, such as SSI, pressure ulcers, and CRBSI, can add $26,000 to $30,000 (or between 47 to 70 percent) to the cost of the hospital index stay. Even the less costly medical harms, such as CAUIT, HAUTI, VTE, and falls, can add anywhere from $6,000 to $18,000 (or between 30 to 50 percent) to the cost of the index stay. The lowest-cost harms were birth and obstetric traumas, which ranged from between $100 and $200 for obstetric traumas without instruments to $920 for birth traumas. Furthermore, some inpatient harms also led to increased risk of a readmission, thereby increasing the likelihood of costly stays following the original stay during which the harm occurred.