States not prepared to deal with medical errors
States not prepared to deal with medical errors
When the Institute of Medicine’s (IOM) recent report "To Err is Human" detailed medical errors that kill an estimated 44,000 to 98,000 people in U.S. hospitals each year, many state agencies and legislatures became interested in addressing the problem.
But a survey of states by the National Academy for State Health Policy in Portland, ME, indicates states are not ready to make real headway in reducing medical errors. The IOM said it believes the majority of medical errors do not result from individual recklessness. Rather, they flow from basic flaws in the way the nation’s health system is organized. The group made four recommendations to create financial and regulatory incentives that can lead to a safer health care system:
1. Create a national center for patient safety within the Department of Health and Human Services that would set national safety goals, track progress in meeting the goals, and invest in research to learn more about preventing mistakes.
2. Establish a nationwide, mandatory public reporting system so that hospitals, and eventually other places where patients receive care, would report errors to state governments.
3. Mandate periodic reexamination of doctors, nurses, and other key providers by licensing and certifying organizations.
4. Build a culture of safety within all health care organizations.
Given the public and legislative interest in medical errors, the National Academy for State Health Policy wanted to learn whether states were prepared for the role envisioned for them by the IOM.
The National Academy found that only 15 states require mandatory reporting from general and acute care hospitals of adverse events defined in a way that meets all or part of the IOM’s definition. The IOM’s report defines "error" as a failure to complete a planned action as intended or the use of a wrong plan to achieve an aim. It points out that not all errors result in harm to a patient.
National Academy policy analyst Jill Rosenthal says one of the surveys major findings was the lack of agreement among states — even among those with reporting requirements — on the definition of "medical error" and "adverse event." No state has a definition of medical error; two states use the term adverse event. Six states have a standard definition of a term that is similar to adverse event, but the term and the definition vary among the states. Seven states reported that they do not have a standard definition of adverse event, but instead specify the types of events that must be reported. "The terms vary quite a bit, and there’s confusion over definitions," Ms. Rosenthal says. "It would help states if there were some uniform definitions. They’re looking to each other for that right now."
Part of the problem with states being responsible for receiving reports of medical errors, she says, is that when Medicare was first adopted in 1965, it allowed states to use Joint Commission on Accreditation of Healthcare Organization’s accreditation as evidence of compliance with the minimum health and safety requirements necessary for participation in Medicare. This "deemed status" approach saved states money because they did not have to do their own inspections. Now states may need to look at rebuilding that unneeded and unused health care facility inspection infrastructure.
In addition to the 15 states that now mandate hospital reporting, five states and the District of Columbia have voluntary reporting of medical errors or adverse events, and six states have reporting legislation pending.
But consistency even is lacking among the states that mandate reporting. Twelve of the 15 states that require reporting from hospitals cover unexpected patient deaths but, beyond that, there is a lot of variability in the types of events that must be reported, including major loss of function, wrong site surgery, and medication errors.
Of the 15 states that require mandatory reporting from acute care hospitals, 13 also require reporting from freestanding ambulatory care centers, and 12 require reporting from psychiatric hospitals. For the states that collect reports, they most frequently aggregate the data to identify trends.
States cited underreporting and inadequate resources as their two greatest concerns with a reporting system. "Using medical error reporting data to improve public safety is still an issue with which states are grappling," Ms. Rosenthal says. "Two states are using data to develop quality improvement projects, and many others noted this area as one of their greatest technical assistance needs."
To help the many states that are looking for technical assistance, the academy is telephoning and visiting all states that have reporting requirements with an eye to issuing a more detailed report this summer. "States are looking to each other for help," she says. "No one wants to reinvent what already exists.
"More than 40 bills have been introduced in state legislatures, indicating a lot of interest in this subject. There’s still a way to go to find an effective way to address the issue. There’s no one right approach. It will vary with each state’s structure and political climate." n
Medicaid, Medicare funding are at heart of Utah hospital’s troubles, director says
Administrators of the University of Utah Hospital, facing a $1.2 million deficit, plan a number of cost-saving measures.
Rick Fullmer, the hospital’s new executive director, blamed the deficit on rising costs of drugs and medical supplies, reduced federal health care spending and lower reimbursement rates from insurers. At the heart of the hospital’s problems are Medicare and Medicaid spending cuts, Mr. Fullmer told the Associated Press.
University hospital isn’t alone in feeling the pinch, he added. By some estimates about 80% of teaching hospitals nationwide will lose money this year. To stem the losses, Fullmer plans to increase the number of patients handled at the hospital and its clinics, eliminate some jobs, scrap or reorganize unprofitable programs and squeeze salary and retirement benefits.
University Hospital, which has 2,800 employees and 400 beds, is the state’s largest hospital-based provider of ambulatory care services. It operates 80 general and specialty clinics around the state.
The hospital already has eliminated 50 full-time positions through attrition.
Fullmer contended the changes will not harm patient care or coverage. Fullmer also expects to increase revenue next year by boosting the patients seen by 10%.
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