QuIC report urges national error reporting system

President Clinton ordered the formation of the Quality Interagency Coordination (QuIC) task force in March 1998 to ensure better coordination among the executive agencies with jurisdiction over health programs. QuIC’s most influential action to date has been its response to the Institute of Medicine’s (IOM) report on medical errors, in which QuIC outlined the federal response to the IOM report. The QuIC report released in February is a strong endorsement of the major IOM objectives, though QuIC does outline some potential problems and shortfalls.

"The QuIC fully endorses the IOM’s goal of reducing the number of medical mistakes by 50% over five years and has developed a strategy that builds on the IOM recommendations and, in some cases, goes beyond them," the QuIC report says.

These are some key points of the QuIC report:

o Creating a center for patient safety.

The IOM recommends that Congress fund a Center for Patient Safety within the Agency for Healthcare Research and Quality (AHRQ) that will set national goals for patient safety, track progress in meeting those goals, and issue an annual report to the president and Congress.

QuIC response: The administration endorses the IOM recommendation, and the president has included $20 million in the fiscal year 2001 budget to support a Center for Quality Improve ment and Patient Safety at the AHRQ, as part of the agency’s broader quality agenda. The center will fund research on medical errors, principally through extramural grants and contracts. It will work with private-sector entities and public- sector partners, including the Quality Forum, to develop national goals for patient safety, issue an annual report on the state of patient safety nationally, promote the translation of research findings into improved practices and policies, and educate patients, consumers, and health care providers about patient safety.

o Establishing reporting systems nationwide.

The IOM recommends the development of a nationwide mandatory reporting system to provide for the collection of standardized information by state governments about adverse events that result in death or serious harm. The IOM report does not propose the establishment of a national voluntary reporting system; rather, it offers a variety of options for more limited voluntary reporting systems that function in all 50 states and build on currently existing options, including the development of systems focused on selected areas — such as medications, surgery, and pediatrics — or using a sampling technique to collect the full range of information from a limited subset of health care providers. It also recommends that the Congress extend peer review protections to data related to patient safety and quality improvement collected through voluntary reporting systems.

QuIC response: The administration agrees with the IOM that error reporting systems should be established in all 50 states and that those systems should have both mandatory and voluntary components. The QuIC agrees with the IOM that individuals should have access to information leading up to and including the occurrence of a preventable error that caused their serious injury or the death of a family member. However, the QuIC says subsequent root-cause analyses undertaken to determine the internal shortcomings of the hospital’s delivery system should not be subject to discovery in litigation, and appropriate legislation should be enacted in conjunction with or prior to the implementation of mandatory or voluntary reporting systems.

It is important to note that the QuIC says any legislation or administrative intervention in this area should not undermine individuals’ rights to redress for criminal activity, malpractice, or negligence. The QuIC does not support legislation that would allow safety reporting systems to serve as a shield for providers engaging in illegal or negligent behavior.

Mandatory reporting systems. The QuIC supports the development of state-based systems to require the collection of standardized information on preventable adverse events that result in death or serious harm, and it says that the development of those systems are ultimately in the best interests of patients. The QuIC agrees with the IOM that the scope of events targeted by mandatory reporting systems that contain public disclosure components should be limited to serious, preventable, and identifiable adverse events. By limiting required reporting systems to the most serious of errors — those causing lifelong disability or death — this approach will most effectively target egregious problems and minimize the cost of operating such a system.

The QuIC says that, once mandatory systems are fully implemented, such information for each health system should be consolidated and made public, but there should be no identification of patients or individual health care professionals. The QuIC also says mandatory reporting systems that contain public disclosure components should not be used as a tool for punitive action by state and local authorities, but they should be used as a mechanism to provide the public with information about the safety of its health systems and to highlight errors that can and should be prevented.

Voluntary reporting systems. The QuIC agrees with the IOM that voluntary reporting systems are a critical component of a national strategy to reduce errors. Information from voluntary reporting systems is usually gathered by an independent entity and is used to identify patterns of errors. The QuIC proposes to integrate existing federal voluntary reporting systems with data collection efforts by states and private organizations. The QuIC agrees with the IOM that those programs should be confidential to protect the privacy of patients, institutions, and providers reporting errors and close calls. Experience in other industries demonstrates that confidentiality encourages reporting. To encourage the development of voluntary reporting systems, the administration will implement a voluntary reporting system nationwide for Veterans Affairs hospitals. The VA currently operates a mandatory reporting system. By the end of the year, the VA will implement a voluntary reporting system for both adverse events and close calls nationwide. Infor mation will be collected by an independent external entity, analyzed, and disseminated to all VA health care networks to help prevent medical errors.

(The entire QuIC report is available on-line at http://www.quic.gov.)