In nineteen ninety nine, the well-respected Institute of Medicine released a report claiming hospital mistakes were responsible for the deaths of up to ninety eight thousand patients a year.
As bad as that sounds, some think the situation is worse.
Angood: Many feel that the number of deaths related to medical errors is probably higher than that number.
Dr. Peter Angood is vice president and patient safety officer for the Joint Commission on Accreditation of Healthcare Organizations.
The Commission is an independent non-profit that evaluates fifteen thousand healthcare facilities nationwide.
Angood says accidental death is the most rare outcome of a medical error.
There are also the more common adverse events, which cause any effect on a patient.
Angood: And certainly the number of events, adverse events if you will, related to errors in care is obviously much higher than that. Probably felt to be somewhere on the order of three to five percent of hospital admissions.
It's nearly impossible to get a handle on whether this nationwide estimate holds true for New Hampshire.
There aren't a lot of data on the rates of medical errors.
What we do know from data collected by the Joint Commission is that New Hampshire is right about at the national average for very serious mistakes.
They've recorded thirteen in the state over the last decade.
But the Joint Commission estimates it collects only about one percent of the major errors that occur in the country.
Another way to look at errors may be as a function of quality.
State medical director Dr. William Kassler says quality in this state is known.
Kassler: Consistently over time and over many different studies the healthcare quality in New Hampshire rates amongst the highest in the country. Whether you're looking at Medicare or Medicaid. Whether you're looking at any number of different indicators of quality we do quite well in New Hampshire.
For example, the Centers for Medicare and Medicaid Services released this year a website called hospital compare.
It rates hospitals in how well they treat patients for heart attacks, heart failure, and pneumonia.
Of the seventeen categories, New Hampshire hospitals scored above the national average on fifteen of them.
And a recent report in the New England Journal of Medicine found that hospitals in the Northeast and Midwest provide better care than in other parts of the country.
Kassler says that although the relationship between errors and quality is intuitive, it hasn't been proven.
Kassler: They're not the same thing. And we're hampered by a lack of data to measure medical errors and mistakes and the poor outcomes that result from that.
Kassler might not have the data, but they do exist.
Ever since the nineteen ninety nine Institute of Medicine Report, the best run hospitals have made major efforts to collect and analyze error information.
Concord Hospital CEO Mike Green says staff there is encouraged to report everything, even if nothing bad happens to the patient.
Green: There are thousands upon thousands that we catalogue. And the number of those that result in patients' harm are really the minimus over that number. Again, the thousands--I don't want to make it sound like there are errors taking place rampantly but when you talk about medications being delivered at the wrong time, a patient who may not get aspirin when they've had a heart attack. We track in minutiae everything that goes on within the institution so that we can look for patterns to try to improve upon our own performance.
The most frequent pattern lies in medication errors, often the result of some communication breakdown.
Anne Diefendorf, the Director of Quality Performance at Concord, says the situation in a hospital is ripe for miscommunication.
Diefendorf: If you think of growing up and playing that telephone game and how I passed it to you and you might pass it to Mike. A lot gets changed in that translation. Plus the environment, the noise, the busyness the distraction. So we really try as much as there's verbal to confirm that what you've heard is correct we also try to enhance it with written communication.
But written communication has its own problems, and doctors' penmanship is not known to be award-winning.
All these data that hospitals across the country track are typically not exposed to the public, and New Hampshire is particularly reticent.
Twenty two states have statewide reporting systems.
New Hampshire does not.
And of the major errors that the Joint Commission on Accreditation collected, New Hampshire had the least that were self-reported.
Instead, most of the information came from patients or the media.
Marty Hatlie is president of Partnership for Patient Safety and founder of Consumers Advancing Patient Safety.
He says that hospitals' hesitancy to open their files is hindering safety improvements.
Hatlie: I think the issue for the public right now is that we as members of the public continue to think that the healthcare system is safe. When in fact the reality is the healthcare system is full of risk and we need to walk into this with our eyes wide open.
Forcing hospitals to disclose errors has been a point of contention, especially in other states that have adopted a mandatory reporting system.
In New Hampshire, a commission that begins in August will pool error information from all hospitals in the state.
But the information is voluntary and confidential.
Hospitals say the public wouldn't be able to interpret the data in any meaningful way.
Hatlie disagrees.
Hatlie: We have to get over that. That's one of the major lines of resistance that I think the healthcare system is at right now that the public won't understand. They will understand and frankly they'll appreciate knowing that people can appreciate this risk and are being honest with them about it.
Diefendorf from Concord Hospital says that first there needs to be standard practices.
Reporting systems vary across hospitals.
If a hospital has a larger number of errors, that might mean it has better reporting, and not necessarily more errors.
And there isn't yet a standard definition of what constitutes an error.
Some hospitals consider a patient fall to be an error, others do not.
Diefedorf says before the public can make sense of error information, hospitals need to agree on what it means.
Diefendorf: We're struggling to say give us some national benchmarks. Because you do want to try and benchmark. Hopefully in the next few years there will be a little more consistency in how people are measuring. I think that's the biggest challenge right now.
Another formidable challenge will be to look beyond hospitals.
Though they have received much of the attention surrounding errors they constitute just one part of healthcare.
There are about six thousand hospitals, and about six hundred thousand physicians.
The problem goes beyond the ICU into the nursing home, into the mental health clinic, into the pharmacy, the doctor's office, and everywhere in health care.
SOQ
To learn more about how New Hampshire hospitals compare to others across the country, you can visit the U.S. Department of Health and Human Services' web site, Hospital Compare.
