Part of a safety scoring trend
We know medical error and unsafe conditions are of enormous interest to payers and patients, and increasingly to providers. The Leapfrog Group and Consumer Reports this year each launched their own hospital safety rating systems. But those algorithms don't report actual harmful events as the AHRQ system would.
While a few hospitals around the country may have plans for internal systems to elicit information from patients about harm or errors they experienced, nationally, no such effort yet exists.
A study of inpatients treated at a Boston teaching hospital in 2003 revealed patients can accurately relate problems, mistakes and injuries in their care, including near misses verified, but not documented in the patient's medical record or its incident reporting system.
I thought the American Hospital Association would be nervous about such an effort. But Nancy Foster, the AHA's vice president for quality and patient safety policy assures me that such a system can inform the patient care process about problems that providers themselves can't see.
She likens it to feedback a dissatisfied consumer is able to give to the manufacturer.
"Patients may be most ideally positioned to tell us when they're getting discordant advice from different clinicians," Foster says. "Maybe a patient was supposed to go into surgery at 10. They got pre-op medications then. But then the surgery was delayed until 4, and they didn't get the medications again. They don't know whether they should have gotten the medications again, but they do know enough to ask the question."
She acknowledges, however, that there could be "a lot of noise in the data collection, things that aren't real signals of patient safety issues. And if that's what AHRQ finds out when it experiments with this, my guess is that they will conclude it wasn't all it was cracked up to be. They may redo the questionnaire to target concerns more effectively or will abandon the notion.
"But until we try, we really won't know."