Patient Safety Issues – When Adverse Health Event Occurs
Adverse Health Event. Minnesota hospitals are committed to doing all they can to prevent avoidable mistakes and improve patient care. Minnesota hospitals have championed an important improvement in how we track and report the most serious medical errors. Initiated by the Minnesota Hospital Association and the Minnesota Department of Health and created through state legislation in 2003, our system is the first in the nation to be built on the National Quality Forum’s list of 28 reportable adverse events in healthcare (see below), including retained objects after surgery, serious medication errors, pressure ulcers and more.
Through hospital participation in the MHA Patient Safety Registry, hospitals report safety event and medical error information in order to share existing safeguards, identify common safety issues and facilitate new collaborative solutions among hospitals. Minnesota’s approach goes beyond reporting; hospitals gain access to valuable information including benchmark reports and key learnings and action steps from peer hospitals.
The Minnesota Department of Health and MHA produce an annual report of adverse events in Minnesota hospitals, ambulatory surgery centers and regional treatment centers. The state’s eighth public report on Adverse Medical Health Events in Minnesota was released in January 2012.
Guidance for Adverse Health Care Event Reporting
The MHA Patient Safety Registry Advisory Council has been working with the Department of Health on addressing questions about definitions related to the adverse event reporting law. Based on these discussions, MHA is offering these initial recommendations and guidance for AHE reporting. The purpose of these recommendations is to create more accurate and consistent reporting across organizations.
Template for Reporting Policy
This template can be used to develop a hospital policy for Adverse Health Care Event Reporting.
In September 2008, Minnesota became the first state to announce a statewide approach to billing for care made necessary by an adverse event. MHA worked with hospitals and payers to develop recommendations and guidance for implementing the serious reportable AHE Event Billing Policy.
To contact Attorney Kenneth L. LaBore, directly please send an email to: KLaBore@MNnursinghomeneglect.com, or call Ken at 612-743-9048 or toll free at 1-888-452-6589.