Error reporting lacking in medical centers

Issue: March 2008

Despite their predisposition to report dangerous hypothetical errors, few faculty and resident physicians may actually be reporting mistakes.

Researchers surveyed resident physicians and faculty members from three medical centers in the northeast, mid-Atlantic and Midwest areas of the United States about error reporting. The staff was asked about occurrences of mistakes that resulted in prolonged treatment or discomfort or had caused disability or death. They were also asked whether or not their mistakes were reported.

Three hundred and thirty-eight participants responded to the survey, resulting in a 74% response rate. The improvement of quality of care as a result of error reporting was recognized by 84.3% of participants.

Though 73% of respondents said they would probably report a hypothetical error resulting in minor harm to a patient and 92% would report an error resulting in major harm, 17.8% had actually reported a minor error and 3.8% had reported a major error.

The researchers found that, in terms of how to report an error, 54.8% of participants had the knowledge and only 39.5% knew what types of mistakes to report. – by Stacey L. Adams

Arch Intern Med. 2008;168:40-46.

There are four factors that are impairing our ability to provide the best care for our patients:

1. We have scarce resources. When you consider the health care environment, we have hospitals that are understaffed, a major shortage of nurses nationwide and a shortage of facilities. So, is error reporting the best use of health care dollars? Should we be telling nurses that now we want them to record extra data because we are trying to measure this, that or the other thing? I think Twila Brace summed it up well when she said, “At a time when hospitals are facing staffing shortages and health care premiums are skyrocketing, every minute and every health care dollar should be used for taking care of patients in an attempt to avoid medical errors rather than reporting statistics to show how few there really are.” So, people are going to question if this really is the best use of scarce resources.

2. The “performance measures” and reporting adds another layer of complexity to the medical decision-making process. And now, if you are a hospital administrator or a physician running your own practice, the first question that is going to hit you when there is a patient in front of you is, “will this patient help or hurt my statistics? Will this make my hospital, my practice or me look bad?” When working with patients, it only takes a couple of minutes to get a feel for that. And, if the patient is going to hurt statistics then they are shuffled off to someone else because doctors want good statistics; I think that is important.

3. To have a valid measurement in terms of statistics and measuring health care performance, you need a constant. Because patients are not identical, a doctor’s reputation cannot be determined by the patient’s results.

4. People seem to be under the impression that the information to help them choose a physician, hospital, treatment or drug is not available. But, the reality is that information is available in the community and it is available to patients. For example, if a patient needs to see a primary care physician out of state but the primary care doctor recommends a cardiologist, the doctor will choose the best cardiologist they can because they have worked with many cardiologists in the community, they have a feel for who does what, they get feedback from the patients and reports from the doctor; there are multiple factors the doctor will look at. If the cardiologist recommends a cardiac surgeon, he will send the patient to the best cardiac surgeon he knows because he wants the patient to have a good outcome. That system works fine. What is happening now is restrictions are being placed on doctors because patients cannot see the recommended doctors because their health care plans will not cover it. So that results in doctors telling patients to choose a cardiologist or cardiac surgeon and see them. All of these interventions have occurred in the medical marketplace and have hindered and limited the information from getting to the public. The third party interventions hinder the ability of the patient to get the care they need and the ability of the physician to refer the patient to who they think is the top doctor.

– Richard Dolinar, MD

Endocrine Today Editorial Board member

Senior Fellow in Healthcare Policy at the Heartland Institute, Chicago