In an indication that individual hospitals may have trouble addressing medical errors on their own, the Rhode Island health department knocked the performance of the state's 14 private and state-owned acute-care hospitals in reporting medical errors and reviewing patient records for lapses in quality.
Three of the 14 hospitals were violating federal peer-review laws, and six were considered deficient in their practices and given advice on improvement, the department said in a report to the state Legislature. Department representatives visited each hospital for several days from January through August this year.
Also coming up short were the state's efforts to monitor medical errors. Since the investigation, the health department has clarified what qualifies as a reportable event, instructing hospitals that a reportable medical error is an unexpected outcome for any given procedure, such as a nosocomial infection. Some hospitals had sought to exclude certain events, arguing they were covered in patients' informed consent forms, said Donald Williams, the department's associate director of health-services regulation.
Hospitals' woes monitoring quality, however, aren't their fault alone. A shortage of healthcare workers, slow claims processing and tightening reimbursement are hindering hospitals' efforts, the department said in its report.
Hospitals have been required to report medical errors and other adverse patient-care incidents to the state since 1994. Last year's total of 158 incidents was the highest to date. All told, 801 incidents have been reported since 1994.
Meanwhile, the number of patient complaints about care skyrocketed to 206 in 2000 from 12 in 1989. The number of substantiated complaints was significantly lower, rising to 25 last year from five in 1989.