Interim guidance leads to first list of approved PSOs

Common formats for reporting established

As final guidance is hammered out on the Patient Safety and Quality Improvement Act of 2005, interim guidance from the Department of Health and Human Services (HHS) on the criteria for becoming a patient safety organization (PSO) has allowed the The Agency for Healthcare Research and Quality (AHRQ) to officially designate PSOs.

Listed Patient Safety Organizations

As of press time, 15 official PSOs were listed on AHRQ's web site. (See box, left, for full list.)

Thinking about becoming a PSO?

Who can apply to be a PSO?

William B Munier, MD, director for the AHRQ's Center for Quality Improvement and Patient Safety, says, "very simply stated, it's pretty broad."

The guidance allows for-profit, not-for-profit, government, and non-government entities to apply for status as a PSO, but excludes insurance companies or components of insurance companies. The proposed rule, Munier says, added that accrediting bodies also would not be applicable for much of the same reason as insurance companies compromise the culture of safety and open disclosure intended with the PSO legislation.

"There's a couple of things to think about" in deciding whether to apply for PSO status, Munier says. "There is a requirement that the primary mission of the entity be improving patient safety and quality." The main mission of a hospital, he adds, should be treating patients "and that's a little different than providing care so that's one thing to keep in mind."

Another is that an entity interested in applying to be a PSO can establish a unit or component with the primary mission of safety. Such a unit would not have to be separately incorporated, Munier explains.

Among the newly approved PSOs, there is the Plymouth Meeting, PA-based ECRI Institute, "which is really a prototype of a PSO if you will," Munier says; the Horsham, PA-based Institute for Safe Medication Practices, "which has been doing medication safety as its principal function for a long time" and the Oak Brook, IL-based University Healthsystem Consortium, which "has a very sophisticated paper safety reporting system that it uses and makes available to a bunch of other people."

Common formats issued

As the legislation begins to take tangible form with official PSOs, HHS Secretary Mike Leavitt instructed AHRQ to issue common formats for reporting "so that the information being collected would be interoperable, both electronically and clinically" across PSOs, Munier says.

Called Version 0.1 Beta, the common formats AHRQ has created address acute care hospitals and are open for comment and review — a process that Munier expects to be an ongoing one "so there's never a final set." (To see the common formats, go to www.psoppc.org/web/patientsafety.) Other settings will be addressed as more formats are created.

Long-term expectations

While the legislation continues to be hammered out and definitions continue to be refined, Munier says, the agency "hopes, over time, that we will be able to get to some kind of comparative benchmarking [with the data collected by the PSOs]." But, he says, challenges with that are twofold.

One, because it is a voluntary reporting system, the level of reporting and the completeness of reporting could vary, and there is no authority to demand otherwise. Second, surveillance systems vary by hospital so "denominators are fairly difficult to come by," Munier says. "And you need denominators if you're going to establish rates or compare providers. I think in the early days of PSOs, we're talking about a learning system where we learn from what happens."

But he refers back to the intent of the law — to encourage disclosure in a confidential, non-punitive system, and he encourages hospitals "to do what they've always said they wanted to do" — to find a local PSO and begin a reporting relationship. Though there is a lot left to be seen about how PSOs will work, to Munier, this move forward signals a great thing — finally, "uniform national protections for peer review," he says.

(Editor's note: The final rule is expected by the end of the year.)