Investigation by HHS finds many unreported errors

Patient Safety Monitor Insider

January 11, 2012

According to a report from the inspector general of the Department of Health and Human Services (HHS), 85% of adverse events are not recognized or reported by hospital staff members, and hospitals seldom update their practices to prevent the same mistakes from occurring repeatedly. A recent New York Times article notes that the major issue in error reporting does not seem to be that employees are afraid to report errors, but rather that many hospital employees are not aware of what constitutes an adverse event or deserves reporting. 

During a thorough review of 293 cases in which patients were harmed, federal investigators discovered 40 cases were reported to hospital managers, and five of the cases resulted in policy changes. The Centers for Mediare & Medicaid Services, incollaboration with the Agency for Healthcare Quality and Research (AHRQ) plan to create a list of events to report and will encourage hospitals to provide employees with explicit information regarding error reporting.   

Source: New York Times