Hospital incident reporting systems captured only an estimated 14 percent
of medical errors, according to a new study from the Office of the Inspector
General and the Department of Health and Human Services. As
San Diego medical malpractice attorneys, we are concerned because if errors are not reported, they are more likely
to happen again.
In conducting the study, researchers looked at the medical records of 785 randomly selected Medicare
beneficiaries nationwide and identified 293 medical errors that led to
patient harm. They found that hospital staff reported only 41 (14 percent)
of those errors, although all of the hospitals had incident reporting
systems designed to capture events.
The study further revealed that hospitals only reported two of the 18 most
serious medical errors, which had led to permanent disability or death.
Moreover, only five of the cases led to changes in polices or practices
by hospitals to prevent future harm to patients.
Serious events not captured by incident reporting systems included hospital-acquired
infections, such as a case of septic shock leading to death; and medication-related
events, such as four cases of excessive bleeding because of the administration
of blood-thinning medication that also led to death.
Because hospitals rely on incident reporting systems to track and analyze
events, improving the usefulness of these systems is critical to hospitals’
efforts to improve patient safety. Based on these findings, the Inspector
General has recommended that the Centers for Medicare and Medicaid Services
provide hospitals with a standard list of medical errors that should be
tracked and reported to the agency.