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Little Sign Of Washington Hospitals Becoming Less Error-Prone

Swedish hospital entrance
John Ryan

US hospitals harm one out of every seven patients they aim to help. So-called “adverse events” inside hospitals are one of the leading causes of death in America.

Since an Institute of Medicine report drew a spotlight to the problem in 1999, hospitals nationwide have made concerted efforts to reduce their medical mistakes. For the past six years, hospitals in Washington state have been required to report their adverse events to the state health department.

The data in 29 categories of adverse events show few signs of hospitals getting safer. Those events include things like leaving a surgical tool inside a patient, letting a patient fall and be seriously injured, or operating on the left knee instead of the right knee.

“The hope is that if hospitals are more public about their success and failure rates for different treatments, that will really encourage them to improve the quality of care that they’re delivering,” said Tom Gallagher, an internist and researcher at the University of Washington.

Gallagher, who studies patient safety and hospital transparency, said requirements for hospitals to report their problems publicly have lit a fire under hospital executives. “None of the hospitals like getting a low grade,” he said. “So the hospitals are acutely aware of these public reports and really work hard if they’re below average.”

But if you look at the actual data collected by the state, it’s hard to see what hospitals have achieved for their hard work. The pace of things going wrong in hospitals shows few signs of letting up. Some adverse events, including falls leading to deaths or serious disability, appear to be increasing.

Hospitals perform hundreds of thousands of procedures each year in Washington, with fewer than 300 adverse events reported each year. But many of the events have such severe consequences that hospitals call them “never events” – meaning they should never happen.

“That’s our goal, absolutely!” said John Vassall, chief medical officer at Swedish. Vassall called safety Swedish’s number one concern. “There’s nothing wrong with transparency,” Vassall said. “Human beings are imperfect and errors occur. We shouldn’t try to whitewash things and say we don’t have errors because we do. However, we do have to continue to make progress in reducing their errors.”

Swedish has won national safety awardsthe past three years. But last year Swedish, the state’s largest hospital, also reported leaving sponges or medical instruments inside its patients five times, more than any other hospital in the state reported.

Vassall and other hospital leaders in Washington say the data their hospitals provide to the Washington State Department of Health accurately reflect the safety problems that actually occur at their hospitals. Other safety experts are skeptical.

“Underreporting is definitely a problem,” said Gallagher. “It’s human nature when something goes wrong to want to keep that information to ourselves.” A national studyby the inspector general of the US Department of Health & Human Services found that 85 percent of the time that Medicare patients were harmed in hospitals, it went unreported.

Undiminished or even rising numbers of safety problems reported to Washington’s health department could just mean that fewer problems are going unreported. “I'm confident there's not a conspiracy afoot to intentionally withhold,” said Jeff Selberg of the Institute for Healthcare Improvement in Cambridge, Mass.

He said it takes time for hospital employees to adjust to acknowledging their mistakes and those of their coworkers. “The most important thing is having trust that this data is for learning,” Selberg said. “‘This is how we improve’ as opposed to ‘this data is for judgment,’ and ‘this is how we find the rotten apples and eliminate them.’”

Hospital leaders and safety experts alike said cultural shifts inside hospitals are key to improving safety. They said if employees and patients are less afraid of speaking up when something goes wrong, more problems will get reported, and fewer will happen in the first place.

If you’ve experienced a serious, indisputable and preventable problem at a hospital in western Washington, you can help KUOW report by sharing your story.

Year started with KUOW: 2009