Mistakes were made," everyone now seems to acknowledge. But what kind of mistakes, by what kind of medical professionals, in what care settings, and with what consequences for patients? That's what the American Hospital Association is trying to find out.
In three initiatives-a broad-based quality advisory, a simple survey and a longer assessment tool yet to come-the AHA is casting its net to get some basic data on hospital-based medical errors.
On Feb. 15 the AHA reissued its quality advisory, which was first issued Dec. 7, 1999. It detailed some basic steps to improve medication safety.
A one-page survey, designed to show where each hospital lies on a scale of readiness and implementation, was attached with the advisory. The advisory and questionnaire are posted on the association's Web site, www.aha.org.
The AHA in March will issue the Medication Safety Self-Assessment prepared by the Institute for Safe Medication Practices.
All this is in response to last December's Institute of Medicine report asserting that an unreported epidemic of medical errors was killing as many as 98,000 Americans a year.
Washington is gearing up to pass some form of medical-error legislation and to fund quality-monitoring and -improvement programs. The AHA wants to ensure it has up-to-date data on what practices hospitals use to prevent errors.
The AHA's stepped-up program is apparently partly a lobbying effort to make sure the association can represent the industry in the most positive light as well as a genuine effort to gauge the range of hospitals' abilities to track and fight errors, and their willingness to take on this issue.
The longer self-assessment, said Don Nielsen, M.D., the AHA's senior vice president for quality leadership, will require participation from a number of people within an institution, such as the pharmacy director and the chief medical officer.
The AHA wants hospitals to complete and return the one-page survey by March 15. It assures them that their specific data will remain confidential. Confidentiality of error reporting is the linchpin to resolving the issue in Congress and in the field.
Becky Miller, director of quality at the Missouri Hospital Association, has seen a draft version of the self-assessment tool to be issued in March.
"It's somewhat lengthy, very comprehensive," she said. "It's a good tool to gather data on what's going on inside hospitals."
The state association isn't getting a lot of inquiries from members on the topic, Miller said. "Hospitals have been dealing with this for years, so it's not new on their radar screen," she said. "There's just heightened awareness from the media and government."
Linda Quick, president of the South Florida Hospital and Healthcare Association, interrupted an interview to participate in a conference call with AHA officials on the subject of President Clinton's mandatory reporting initiative.
"On the call today, they talked a little about Clinton's stuff," she said later. "They're suggesting that states develop mandatory systems of serious issues and voluntary reporting of close calls. This state already has one. They are saying that if they don't get cooperation from states, they might consider going back to a national system. As long as you prove you have a system, they won't hassle you at the federal level."
The South Florida organization is going to choose one common error at all member hospitals and try to achieve a regional reduction in that error rate.
Quick said the local association has also been paying attention to media and public response to the error issue. "I haven't gotten the same kind of response we got when University Community Hospital in Tampa (Fla.) operated on a man's wrong foot," she said. "I haven't gotten requests from the public or the media to guarantee that there aren't errors in the system."
Joe Bujak, M.D., vice president of medical affairs at Kootenai Medical Center in Coeur d'Alene, Idaho, said his hospital made a major effort to address medication errors six months before the IOM's report became public.
Now the hospital's rate of reported errors is much higher than before. "We're getting more accurate reporting," Bujak said. "We had terrible collection methods. Step one was to develop a way of profiling medical errors. When you do that, the rate goes up."
Most drug errors fall into the category of near-misses, Bujak said. "When physicians heard the data from IOM, our docs said, `Baloney. We can't think of anybody who died because of that,' " he said.
"But we can't point those out because we don't put on the death certificate that they died of an adverse drug event," he said. "If somebody comes in with pneumonia and you prescribe the wrong drug, they die. The cause of death is listed as pneumonia. But it's really a drug error," he said.
"The Institute of Medicine is bang-on right. Hospitals are very dangerous places to be," Bujak concluded.