By Allison Hughes
Serious Reportable Events are divided into six categories, including: environmental, surgical, care management, criminal, product/device, and patient protection.
Some examples of the types of incidences that are counted in each category include:
Environmental:
-Patient death or disability due to a fall
-Patient death or disability due to a burn
-Patient death or disability due to an electric shock
-Contamination in a patient's gas line
Surgical:
-Surgery performed on the wrong body part
-Surgery performed on the wrong patient
-Wrong surgery performed
-Foreign object left in the patient during surgery
Care Management:
-Patient death or disability due to medication error
-Artificial insemination with the wrong donor sperm or donor egg
-Severe bedsores
-Patient death or disability during a low-risk pregnancy or delivery
Criminal:
-Sexual assault of a patient
-Abduction of a patient
-Patient or staff injury due to a physical assault
Product or device:
-Use of contaminated drugs
-Malfunction of a medical device
-Misuse of a medical device
Patient Protection:
-Patient suicide
-Infant discharged to the wrong person
To find out how your local hospital ranked, visit the Department of Public Health's Web site or view the whole 2009 report by clicking here.
Massachusetts hospitals reported more than 500 serious medical errors in 2009 that resulted in injury, disability or death of patients, according to a report released by the Department of Public Health.
The number of reported medical errors increased by 15 percent since 2008, from 442 reported events to 510.
"It doesn't necessarily represent a quality concern," said Elizabeth Daake, director of policy development and planning for the Bureau of Health Care Safety and Quality. "We consider this a positive sign that we are getting more reporting."
This is the second annual report on hospital errors, which are referred to by the Department of Public Health as "Serious Reportable Events" (SREs).
According to John M. Auerbach, commissioner of the Massachusetts Department of Public Health, more accurate reporting could account for some of the increases but not all.
"I think there are different SREs where there's a greater or lesser likelihood of more accurate reporting," he said.
The report focused on the errors that occurred at hospitals with 24-hour, emergency short-term care. Over three-quarters of all medical errors occurred in these types of hospitals.
The largest medical error increase was seen in the frequency of pressure ulcers in patients, commonly known as bedsores, with 65 reported compared to 12 reported in 2008.
"In terms of the pressure ulcer, that's where it's a relatively new arena for feeling like we're getting accurate reporting," said Auerbach.
Unlike pressure ulcers, Auerbach said hospitals have a long history of accurately reporting serious falls and surgical errors.
The amount of disabling or deadly falls declined in 2009, from 224 to 199.
The report showed an increase, however, in certain surgical errors. The number of foreign objects left in patients after surgery increased nearly one-third, from 32 in 2008 to 42 last year. The number of wrong surgical procedures increased from 5 in 2008 to 9 last year.
Dr. Alan C. Woodward, an emergency physician and member of the Public Health Council, said it might be difficult for hospitals to know which incidents should be defined as SREs. "Some of them are absolutely black and white," he said. "Some of these are more gray zone."
According to Woodward, the report should be the first step in seeking solutions for frequent errors. "I'm just trying to figure out, 'How do we get something constructive out of this?'" he said.
Daake said collecting and analyzing the data is a necessary step in implementing change. "It's really to help us understand how these events happened," she said.
The report is available to the public on the Department of Public Health Web site. Hospitals will be able to comment on the site, provide updated information, and share their plans to identify and address medical errors.