Quality: Reporting Becomes Hospital-Specific

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New Jersey is among states that require site-specific patient safety reporting.

For six years, New Jersey, like many other states across the country, has issued an annual report on quality—specifying how all its hospitals are doing when it comes to surgical care infection prevention or meeting performance measures for heart attack, pneumonia, or congestive heart failure. But in 2009, it became one of the first states (along with Minnesota) to add a new type of measure to the public report: hospital-specific patient safety indicators.

Earlier in the year, the New Jersey governor signed legislation that required data addressing a dozen patient safety performance issues and serious medical errors be included in the annual New Jersey Hospital Performance Report released this past fall.

This report uses patient safety indicators developed by the Agency for Healthcare Research and Quality or listed by the Centers for Medicare & Medicaid Services as "never events"—or incidents that should never occur—such as surgery on the wrong side, wrong body part, or wrong patient.

Examples of indicators cited in the public report include: excessive bleeding or large blood clot following surgery, serious bloodstream infection following surgery, a foreign body accidentally left in a patient after a medical procedure, postoperative hip fracture, and a patient receiving an accidental cut or injury during a medical procedure.

"What we're trying to do is raise all the boats up in the harbor [at the same time]. Public reporting does that more effectively than anything I know," says David Knowlton, president and CEO of the not-for-profit New Jersey Health Care Quality Institute in Trenton, NJ.

"It's not an attempt to cause hospitals problems in their market. It's not an attempt to embarrass them. It's an attempt to give them data that will force their hand in improving these particular items," says Knowlton, who sat on the panel that helped select the hospital-specific indicators for the public report.

"We have to aim for zero on certain things," adds Knowlton, who is also chairman of The Leapfrog Group, which evaluates hospital patient safety. "I think that's where the healthcare industry should be. A patient should not fall out of bed just because we have a certain number of falls [that are reported annually]. The industry should say it's unacceptable to have a patient fall and break a hip ... We've got to set a high standard, and that high standard is zero tolerance [for] a never event."

The report clarifies that, rather than creating an entirely new data reporting system, the state's Department of Health and Senior Services used data from its available Uniform Bill reporting system. This data does not contain detailed clinical information needed to monitor adverse drug events and cannot capture all aspects of patient complications, the report notes.

"I would say we were a little bit nervous in anticipation of seeing the numbers for the first time. But as a whole, our hospitals supported the bill that mandated that this data be released," says Betsy Ryan, the president and CEO of the New Jersey Hospital Association.

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