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“Never Events” - The Incidence and Cost Implications of “Preventable” Complications in an Academic Urology Practice
Elias Hyams, Brian Matlaga
Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD

In 2008, the Center for Medicare Services enumerated a list of “preventable” adverse events and began restricting payments for associated costs. These included certain unambiguous preventable errors like wrong site surgery, but also certain medical/surgical complications that might result from non-modifiable risk factors. In this study, we investigated the incidence of current or proposed “never events” during a one year period in a tertiary level academic urology practice. Also we sought to quantify inpatient costs directly attributable to these events.
We reviewed a prospectively maintained database of patient morbidity and mortality in our urology department from July 2009-June 2010. Incidence of current and proposed “never events” were collated. Inpatient billing records for infection-related events were specifically reviewed.
Table 1 demonstrates the incidence of various current and proposed “never events.” Infection-related events generated hospital costs of \,428.28 (mean \.83/patient; range \.26-70,151.94).
While “never events” are relatively rare in an academic urology practice, they can generate substantial cost burden if reimbursement is strictly limited. For high risk patients, it may be impossible to determine whether specific events are preventable even when best practices are followed. Furthermore, determining which costs are directly attributable to an event during a complex hospital course may not be routinely feasible. Health care policy that seeks to incentivize quality care needs to recognize these methodological issues.
Table 1.

EventOverall Incidence (5305 cases)Adult Incidence (4032)Pediatric Incidence (1273)
C. difficile infection (6)0.11% (6)0.12% (5)0.08% (1)
Surgical site infection (12)0.23% (12)0.17% (7)0.39% (5)
Catheter-associated UTI (8)0.15% (8)0.17% (7)0.08% (1)
Infected device (1)0.02% (1)0.03% (1)0% (0)
Hospital acquired pneumonia (4)0.08% (4)0.10% (4)0% (0)
Deep venous thrombosis/pulmonary embolism (17)0.32% (17)0.42% (17)0% (0)
Hip fracture (1)0.02% (1)0.03% (1)0% (0)
Anesthesia-related (3)0.06% (3)0.05% (2)0.08% (1)
Positioning-related (5)0.09% (5)0.12% (5)0% (0)
Narcotic overdose (2)0.04% (2)0% (0)0.16% (2)

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