hospital error reporting

Sorry to have been off the grid for so long; but I'm back now. :)

Interesting article in Monday's NYT about the rate at which NYC hospitals are reporting errors. There are apparently huge disparities between comparable institutions, and some of the city's most prestigious hospitals are implicated in poor reporting. New York-Presbyterian, a combination of Columbia-Presbyterian and the former New York Hospital, which now goes by Weill Cornell Medical Center, reported only 20 adverse incidents per 10,000 discharges. Another "comparable institution", which the article did not name, reported 166 adverse incidents per 10,000 discharges. Of the hospitals owned and operated by the city, Bellevue, generally regarded as the most prestigious, is on a list of the 12 lowest reporters released by the city comptroller. Others included on that list are Lenox Hill and Mt. Sinai. The assumption is that these low reporting rates are the result of poor reporting rather than excellent care.

I wish this article was more explicit about to whom these errors should have been reported. The analysis that discovered these disparities was the city comptroller's office, but it seems unlikely, albeit possible, that hospitals are expected to routinely report adverse events to that office. The comptroller's website says nothing about hospitals, although it does include in its list of activities "audits of New York City agencies."

The point of raising this issue is that I wonder if there is a disparity between what hospitals report out and what they monitor internally. I bet there is, due to mostly to two factors: the hospitals' self-interest, and differing definitions of "adverse event". For example, a nurse friend of mine who works in one of the hospitals named in the study accidentally gave a medication intranasally instead of by injection. The patient was fine; the reason the route had been changed was because the intranasal med seemed to have no effect. But she still had to fill out an incident report, etc. because the hospital considered it an adverse event. I doubt errors of this nature were reported to whatever body this is by any hospital, but it was monitored internally by her institution. That is, just because an incident was not reported to an external body does not mean it went unnoticed. I would be curious to know how the external body to which hospitals are supposed to report adverse events defines "adverse event", but I can't find out because I don't know what that external body is If its definition is grave (ie, it's only an adverse event if it results in death or disability) that would mean these hospitals are concealing major errors and underreporting is really a cause for concern. If its definition is more trivial, the underreporting of adverse events is less of a worry, although it obviously shouldn't be tolerated.