Whether the estimated number of medical errors is high or low, forum searches for new answers
Whether the estimated number of medical errors is high or low, forum searches for new answers
Since the Institute of Medicine’s controversial report about the high number of medical errors that occur every year, the debate about the actual number of errors continues. Is it higher than the institute’s numbers of between 44,000 and 98,000 deaths annually? Are the institute’s numbers too high?
A recent gathering of 14 state and federal health care officials, convened by the National Academy for State Health Policy in Portland, ME, didn’t come to a consensus about exact numbers of deaths and errors. No matter what the figures, the group decided, there are too many incidents and something needs to be done to solve the problem.
"There was no clear road map that emerged for what should be done," Trish Riley, the academy’s executive director, tells State Health Watch. "They thought there might be an underestimation on the numbers because the figures were only for hospital-based errors. But most thought it didn’t matter if the number was high or low."
The members of the forum remained anonymous in the report the academy recently issued, "Improving Patient Safety: What States Can Do About Medical Errors." In Ms. Riley’s opinion, the lack of names and titles allowed the attending health care officials to speak their minds without fear of their words coming back to haunt them. The result, she says, is a document that dares to be honest about a public health epidemic that desperately needs attention.
Since states are at the front lines, and woefully underfinanced to fight the battle, forum members say, ways need to be found to shed light on why the errors occur. Getting accurate reporting of adverse events, whether involving mandatory or voluntary reporting, was a concern of forum members. Mandatory reporting, however, according to the forum, does not now provide significant reporting of medical errors.
"Participants discussed the issues of confidentiality of data and the possibilities of extending peer review protections which, by shielding information from discovery, could encourage reporting," the report states. "It was noted that creating voluntary systems may not eliminate underreporting; for instance, the JCAHO [Joint Commission on Accreditation of Healthcare Organizations] reporting system offers JCAHO peer review protection but still does not get significant reporting of errors. While hospitals have had a long history in which they could have established voluntary systems, they have failed to do so, and medical errors remain a serious problem."
By looking beyond the number of adverse events in hospitals, Ms. Riley says, the Institute of Medicine’s estimation may seem low. Clinics and doctors’ offices are a new and expanding realm of potential errors.
"Doctors are doing more and more what was done in hospitals," Ms. Riley says. "If you consider the adverse [potential] there, the numbers may be considerably higher."
The forum noted and approved the move by New York state’s public health commissioner, Antonia Novello, who has made a commitment to following the Institute of Medicine’s recommendation of reducing errors in the next three years. But how would states know if they are reducing the number of adverse events if they do not have a baseline of medical errors to work with? Many of the participants in the forum say mandatory reporting may be the only way to grab reliable statistics.
"States participating in the forum feel that an important first step in addressing medical errors is to examine current data collected by all state agencies to determine which of that data can be used to improve patient safety and gain reliable and validated statistics," the report states. "Participants identified value in having both mandatory and voluntary reporting systems. They noted that the approach taken by the aviation industry in which a mandatory system exists for serious accidents that result in death or serious harm and a voluntary one for near misses’ may be a good model for medical errors as well."
As always when it comes to the intertwining of state and federal government and oversight, there was concern about who should wield the most influence. Forum members generally felt the federal government needs to consider the roles of states in reducing medical errors before it gets too involved. Health reform in the past 25 years, the report states, was led by the states, and it notes that the Health Insurance Portability and Accountability Act and the State Children’s Health Insurance Program only came about after a majority of states had similar programs already up and operating.
Hospital oversight of medical errors by state government is fragmented, forum members agreed, but regulatory agencies and purchasers can make an impact by working together to solve the problem. That work should start with hospitals, they said.
Seeking consensus about medical errors, their numbers and causes is a step toward solutions, the forum members said, and they back the states that have created coalitions that include state governments and hospital associations.
Other suggestions made by forum members to reduce medical errors include:
• Pilot programs in states to develop improved systems of hospital oversight and data collection and analysis.
• Assistance in creating and funding centers for patient safety, like those established in New York and in Massachusetts, to coordinate various state functions related to safety, create or strengthen reporting systems, establish a public relations campaign, focus group testing to get a better sense of the public’s understanding of patient safety, and provide appropriate public education.
• Research projects to assist states in analyzing their data and determining how best to use data to improve patient safety. Similarly, states sought assistance in developing appropriate reporting and data-sharing systems despite conflicting confidentiality and other requirements from differing funding sources and public laws.
• Patient advocacy/ombudsman programs to work on behalf of patients.
• A revolving loan fund or challenge grants for hospitals to upgrade and start patient safety initiatives, such as computerized order-entry systems.
• Trustee education to assure that hospital governing boards are informed about and involved in the issue.
• Studies that address building and sustaining effective mandatory reporting systems, studies on using voluntary systems’ near-miss data, studies on the impact of reporting systems on litigation, and system change.
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