Beginning soon, healthcare professionals in hospitals, pharmacies, and other settings may have a new partner—their patients—in improving the quality of care. It depends on whether or not the Agency for Healthcare Research and Quality (AHRQ) receives approval from the White House for a proposed system that will allow patients to report medical mistakes and unsafe practices.
The proposed system’s goal is to use patient reports of medical errors to help healthcare professionals deliver safer care. Although opinions vary, AHRQ Director Carolyn Clancy believes that the new patient reporting system “could complement and enhance reports from providers and thus produce a more complete and accurate understanding” of medical errors. By better understanding medical errors, healthcare professionals can take steps to reduce them.
According to plans for the proposed system, the federal government would set up methods for patients to report information using either an online or telephone questionnaire. For each medical error, the questionnaire would request information about:
- what happened, including the details of the error
- the date and location of the error
- the type of harm, if any, that resulted
- contributing factors
- whether the patient reported the error and to whom.
The questionnaire would also ask the patient’s opinion about why the error occurred. The patient could choose from possible reasons, such as “a healthcare provider was too busy,” “a healthcare provider didn’t spend enough time with the patient,” and “healthcare providers failed to work together.”
Reporting is voluntary, and any reported information is confidential. However, the questionnaire asks the patient’s permission to share the reported information with healthcare professionals who can use it to make patient safety improvements. Also, researchers from RAND Corporation and ECRI Institute would analyze information in the reports.
If the proposed system is approved, data collection will begin as early as May 2013. Patients will be able to obtain questionnaires at kiosks in hospitals and physician offices and may obtain flyers about the reporting system from pharmacies or receive them by mail from their insurance companies.
Pros and Cons
Consumer groups have welcomed the new proposal. Hospitals and some physicians say it has merit. However, other healthcare professionals and lawmakers have concerns. For example, a group of physician lawmakers have sent a letter to the AHRQ to register their concerns and pose questions about the proposal. These lawmakers noted that “many patients do not have the medical knowledge to accurately determine when an adverse medical event occurs.”
Kevin Bozic, chairman of the Council on Research and Quality at the American Academy of Orthopaedic Surgeons, echoes this sentiment. In his opinion, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge. Because of this, Bozic emphasizes the importance of matching patient or family reports of medical errors with information in the patient’s medical record.
Other critics worry about the reporting system’s effect on malpractice liability and possible financial penalties for poor performance. In 2008, the Centers for Medicare and Medicaid Services began denying Medicare reimbursement for 11 hospital-acquired conditions, such as hospital-acquired infections and injuries resulting from patient falls, and prohibited hospitals from charging patients for them as well. This change has linked Medicare reimbursement to quality of care and puts some hospital revenues at risk. As a result, some fear that the new system could jeopardize revenues.
However, the proposed system also has great support. Research indicates that 25% of patients have experienced adverse events at some point in their medical care but previously have had no way to report them. In addition, many medical errors in hospitals are not documented in medical records. The new system can identify such errors so that they can be avoided in the future.
Martin J. Hatlie, chief executive of Project Patient Care (a Chicago-based healthcare safety coalition), notes that “Patients and their families are a potential gold mine of information. They see things that busy healthcare workers don’t see. Doctors are in and out. Nurses are in and out. But family members are there continuously with the patient. They often know how to fix problems that cause errors.”
By identifying and helping to correct medical errors, this new system could increase patient safety, improve the quality of care and, ultimately, decrease liability.