How patient risks of harm in the hospital have increased during the pandemic: Opinion

Although many in health care are laser-focused on the prevention of COVID-19, the pandemics’ ramifications have had far-reaching effects on our health care system. Even before the pandemic, our health care system had grave problems. A May 2022 U.S. Dept of Health and Human Services report found that in 2018, more than one in four Medicare patients experienced patient harm. During the pandemic, the quality of care only worsened.

The CDC at one time touted health care-acquired infections as a “Winnable Battle,” but now rates of infections are rising with those from Methicillin Resistant Staphylococcus aureus along with ventilator-associated events and central-line–associated bloodstream infections at higher levels than the 2015 baseline. In other words, instead of improving, the risks of harm have increased during the pandemic.

These measurements are risk-adjusted, but even with massaging this data, the pandemic still has placed increased stress on resources, and it is apparent that more needs to be expended to provide the same level of care. The U.S. Congress has allocated pandemic relief funds for this purpose. Unfortunately, it appears many facilities chose to squander this funding, which may have further augmented the risks of harm to patients and health care staff.

For example: While small front-line hospitals struggled, a large report from North Carolina State Health Plans found: That the seven largest hospital systems in the State “… recorded $5.2 billion in net profits in 2021, when six hospital systems made higher net profits than in the years before the pandemic.” And that in 2020, charity spending fell across a third of 104 hospitals. Some even sued patients and increased billing of patients eligible for charity care. All-in-all, there was little accountability.

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Facilities appear to be responding by trying to water down regulations and to lessen the efficiency and impact of quality monitoring. For example, during the June 2022 CDC Healthcare Infection Control Practices Advisory Committee meeting, a representative of the hospital industry stated he was:

“… hoping for the future with recommendations that we also take into account, that when we have a recommendation is it something that we can accomplish...”

With record net profits or income which were recorded by major facilities during the pandemic, I’m not sure one can play the “too burdensome” card to avoid the provision of optimal care.

And we received from the CDC were watered-down regulations, with not having specific recommendations to increase ventilation, admission COVID testing at the “discretion of the facility” and the encouragement, but not mandating, the use of N95 masks.  This confusion even caused some facilities to remove N95 masks that patients came in with and replaced them with surgical masks.  The CDC to their credit stopped this practice, but still does not mandate the use of N95s. 

A severely flawed metric designed to measure hospital-acquired COVID-19 was also implemented. One which only counted cases in currently hospitalized patients who develop COVID-19 14 days or greater after admission, and at one time (January 12, 2021 guidance) the patient would not be reportable if “they are no longer symptomatic and are removed from COVID-19 isolation precaution.”

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The January 2022 guidance has dropped the last requirement, but with a median incubation period of approximately 4 days for the Delta Variant and 3 days for Omicron and an average hospital stay of 4.6 days, hence very few patients would be reportable.

From April 1 to Sept. 30, 2020, Kaiser Health News using administrative data reported over 10,000 cases of hospital-acquired COVID-19. Using U.S. Dept. of Health and Human Services’ data, the Wall Street Journal found 4,700 cases of hospital-acquired COVID-19 during the Omicron Wave.

However, this is small in comparison to the United Kingdom’s National Health Service which reported that up to 20% of hospitalized COVID-19 patients caught COVID in the hospital. The estimates of the hospital-acquired COVID-19 in the United States are almost assuredly drastic undercounts, but no one knows because no one is truly counting.

To make matters worse, the Biden administration does not release names of hospitals where patients have contracted COVID and even if they did a plethora of newly enacted state laws, “severely limit” the ability to seek legal recourse. In addition, the watered-down standards-of-care, makes suboptimal care legally acceptable.

All of the above has resulted in many staff not feeling safe, worsening the chronic nursing staff shortage. The CDC must set the highest standards for the world to emulate, not standards that are pliable for our profit-driven health care systems.

Workers and patients need to have a voice at the table, and when billions of dollars are being amassed in reserves, the highest standards should be provided to all who enter our healthcare facilities.

Kevin Kavanagh is a retired physician from Somerset, Kentucky, and chairman of Health Watch USA.

This article originally appeared on Louisville Courier Journal: How risk of patient harm in the hospital increased during the pandemic