Medical errors provide valuable data

23-07-2013

Healthcare organizations have an untapped opportunity to use their own administrative data to prevent future errors, according to a new study from the Drexel University School of Public Health.

Used properly, the data can act as a “springboard to problem identification” at the leading edge of preventing even those medical errors that are not yet preventable.

“For example, a patient may receive a drug in the Emergency Department and develop an allergic reaction, but did not have any known allergies at the time of treatment,” said Dr Jennifer Taylor, an associate professor at Drexel who led the study.

“While such events may not be deemed to be preventable now, we need to start tracking them so our research and development colleagues know what’s next in the prevention pipeline.”

Based the premise that preventing medical errors requires a good understanding of when and where all such patient safety events occur, Taylor and colleagues analyzed large-scale data on hospital stays in Pennsylvania during one year. They compared hospital stays with and without patient safety events, to describe patterns, demographics and differences associated with such events.

They found that nine per cent of the hospital discharges in Pennsylvania in 2006 were for stays with a patient safety event. On average, patients who experienced an adverse event were older, white and male; patient safety events added an average of $35,000 to the cost, and three days to the length, of a hospital stay.

“The percentage of discharges that had a patient safety event is in the range of other studies we’ve seen in the U.S. and around the world,” said Taylor. “While this figure may be a bit startling, it is not a cause for alarm, in that many of the events that we found are adverse events for which there are no known prevention strategies,” as in the example of the unexpected allergic reaction.

Taylor noted that some of Pennsylvania’s additional patient safety data sources make it a promising location to take the population-level analysis even deeper: “Pennsylvania has a strong commitment to patient safety and reporting,” said Taylor.

“Many great data sources exist such as the Pennsylvania Healthcare Cost Containment Commissioner’s state hospital discharge data and the Patient Safety Authority’s Patient Safety Reporting System. In our paper we recommend that these two systems be explored to discover how Pennsylvania can make even more advances in understanding the scope of the problem and how we should leverage our unique commitment to data into prevention opportunities.”

 

Medical errors, valuable data, development, hospital, healthcare risk management