Unlike New York, the Joint Commission on Accreditation of Healthcare Organizations doesn't try to track all the accidental deaths or serious injuries that result from medical mistakes. But it gets just enough to work with to move providers toward changing their ways, said President Dennis O'Leary.
In nearly 10 years of collecting mainly voluntary reports of unanticipated serious or fatal mistakes, dubbed sentinel events, the accrediting agency has 2,768 on file, according to the latest count. In recent years it has logged about 450 per year, with 400 so far in 2004-less than 1% of the probable total, O'Leary said.
A patient-safety accreditation standard inaugurated in 2001 has yielded just 14 instances of hospitals failing to follow a requirement to inform patients and families of the outcomes of care and treatment, including "unanticipated outcomes" leading to harm, said Russell Massaro, JCAHO executive vice president of accreditation operations.
What counts is not rounding up all the mistakes but rather figuring out why they happened and alerting clinicians to the threats and preventive measures, O'Leary said. The disclosures and analyses of the root causes of reported sentinel events have proven sufficient to yield 30 alerts about specific dangers and how to prevent them.
Regardless of that achievement, the healthcare industry needs more public accountability to force change quicker, said Blair Horner, legislative director of the New York Public Interest Research Group. "To operate under a shield of secrecy, we don't think that works," he said. "There's a sentinel effect of public scrutiny."
But the reaction to a New York audit's finding of lapses in reporting still leaves the question of whether the information is being collected for constructive or punitive purposes, O'Leary said.
Dwarfing other states in the amount of data collected, New York's reporting system has yielded a trove of trends even with its compliance problems. But a move toward sanctions for incomplete disclosure could harm the quality-improvement effort, O'Leary said. "The New York model implies a punitive model, but they haven't operated as a punitive model, and that's the biggest reason why it works."
Even if administrators wanted to comply fully, "you only know what you know" about medical mistakes-"some are easy to hide" if clinicians fear repercussions, he said.
The same could be said of the requirement that providers fess up to patients and their families about adverse outcomes of care. Compliance is only addressed in accreditation surveys-surveyors don't have information on a sentinel event unless it was voluntarily reported or tipped to the press or by other agencies such as the CMS, Massaro said.
Surveyors search for sentinel events by checking charts for the signs: unplanned transfers to a more-intensive care setting after surgery, for example. Then they backtrack to see whether disclosures to patients were documented, he said.
In the last six months of 2001, the JCAHO cited five hospitals for noncompliance with the accreditation requirement. In all of 2002, eight were out of compliance, one in 2003. None have been cited this year.
Massaro said the gradual drop-off can be explained as a trend toward being straight with patients to avoid bigger problems by withholding the truth. "It's like what politicians need to learn: When you make a mistake it's better to own up in the beginning. It's the coverup that gets you."