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Nevada Hospitals Are Hiding Loads of Medical Errors -- and So Are Hospitals Across the U.S.

If sunlight is what's needed to cure the epidemic of medical errors in hospitals, we're currently living in permanent twilight. That's the conclusion of a recent two-year investigation of Nevada hospitals by the Las Vegas Sun, which showed that hospitals are reporting only a small fraction of their serious mistakes to the state.

And Nevada hospitals aren't unusual. There's evidence that facilities across the country continue to hide their safety lapses. That not only inflicts unnecessary pain and suffering on patients but also drives up the cost of healthcare, which harms other patients by limiting their access to care. The Sun investigation looked at hospital billing records for 2.9 million inpatient visits that have been submitted to the state over the past decade. The state also requires hospitals to report "sentinel events" in which patients are harmed or threatened with harm. According to the Sun, there were 1,363 occurrences that fit the definition of sentinel events in 2008 and 2009. But Nevada hospitals reported only 402 sentinel events for those years.

In other words, there was a big discrepancy between what the hospitals reported to the state and what their billing records revealed about medical errors they actually treated. Here are a few examples:

All of the hospitals in the state reported only one advanced-stage decubitus ulcer -- a bedsore that has been allowed to progress to a crater of dead flesh that can extend to the bone. But the investigation found 72 such ulcers.

The hospitals reported just one central-line infection, which can result when a catheter is placed in a patient to administer drugs. But the Sun identified 336 central-line infections in that period.

The hospitals divulged seven cases in which a foreign object was left in a patient's body during surgery; the investigators found 17 such cases.

In the wake of this groundbreaking analysis, the state now plans to audit hospital medical records in order to find out what's really going on. Meanwhile, it turns out that many other states collect hospital billing records, just as Nevada does. If they analyzed this data and publicized their findings, it could shine a light in a dark corner that badly needs to be illuminated.

Of course, hospitals are vehemently opposed to such transparency. In 2002, when the Nevada legislature was debating the "sentinel event" reporting law, a hospital industry spokesman argued that making such information public would compromise patient confidentiality and the physician peer review process, would be costly for hospitals, and was not guaranteed to reduce errors.

A few years ago, the Joint Commission, which accredits hospitals, began requiring them to report "unexpected outcomes" -- another term for sentinel events. A hospital survey done soon afterward revealed that a majority of hospitals disclosed medical errors at least some of the time. But they were less likely to divulge preventable errors that ones that could not be avoided, according to the poll.

While researching a story on hospital safety, I obtained some data from the Joint Commission on the number of sentinel events that all accredited U.S. hospitals had reported in 2008 and 2009. The data showed that errors of certain kinds were continuing to increase: e.g., 126 wrong-site surgeries were reported in the first nine months of 2009, up 34 percent from the same period a year earlier. Medication errors nearly tripled from 2008 to 2009 (see chart)

Sentinel Event

1/1-9/30/08

1/1-9/30/09

% change

Wrong-site surgery

94

126

+34%

Suicide

79

72

-9

Delay in treatment

53

79

+49

Unintended retention of foreign body

53

94

+77

Patient fall

49

34

-30

Op/post-op complication

46

65

+41

Medication error

35

97

+277

Assault/rape/homicide

31

27

-13

Perinatal death/loss of function

27

29

-7

Patient death/injury in restraints

9

9

0

But maybe the real meaning of this information is how few of these events are actually reported. After all, the Joint Commission accredits thousands of hospitals. Is it really possible that only 65 operative or post-operative complications occurred in all of these facilities from January to September of 2009? Obviously not.

It's past time for the states that have the hospital billing data to subject it to a little quantitative analysis. If they find out that the hospitals have been hiding their errors, and force them to admit the extent of the safety issue, everyone will benefit.

Image supplied courtesy of Edu-Tourist at Flickr. Related:

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