The State of New York mandates reporting of “incidents” that are defined by law [NY PBH §2805-L] with identical language in the New York Code of Rules and Regulation [CRR] for Health [10 NYCCR §405.8. Reportable incidents are defined as:
- b. The following incidents shall be reported to the department:
- (1) patients' deaths or impairments of bodily functions in circumstances other than those related to the natural course of illness, disease or proper treatment in accordance with generally accepted medical standards;
- (2) fires in the hospital which disrupt the provision of patient care services or cause harm to patients or staff;
- (3) equipment malfunction during treatment or diagnosis of a patient which did or could have adversely affected a patient or hospital personnel;
- (4) poisoning occurring within the hospital;
- (5) strikes by hospital staff;
- (6) disasters or other emergency situations external to the hospital environment which affect hospital operations; and
- (7) termination of any services vital to the continued safe operation of the hospital or to the health and safety of its patients and personnel, including but not limited to the anticipated or actual termination of telephone, electric, gas, fuel, water, heat, air conditioning, rodent or pest control, laundry services, food or contract services.
However, it is abundantly clear in §405.8(b)(1) above that there exists alot of room for judgment as to what ‘deaths’ and what ‘impairments of bodily functions’ are not related to the natural course of illness, disease, or proper treatment. In order to deal with the ambiguity of subjective judgment, NYPORTS provides ‘interpretive guidelines’ provided in forms with predefined lists of reportable events.
A sampling of NYPORTS ‘incident’ forms are available on the S U N Y Upstate Medical University (aka University Hospital) Risk Management Functions website or from NYPORTS, as noted:
- ◊ ‘NYPORTS Includes/Excludes List’• (A list of occurrences that constitute the reportable events),
- ◊ Health Department Occurrence Tracking Form [PDF],
- ◊ Medication Occurrence Reporting Form [PDF], and
- ◊ Occurence Reporting Form [PDF]
The NYPORTS Includes/Excludes List provides the interpretation of the ‘incidents’ listed in NY PBH §2805-L that translate to “quasi”-ICD-9-CM-based NYPORTS codes for reporting to NYPORTS. [“quasi” denotes that some codes are hospital-specific and not uniformly defined across all NY hospitals.] These codes are cross-checked against the New York Statewide Planning and Research Cooperative System (SPARCS), which is the database containing information on all inpatient stays in New York State acute care hospitals. The NYPORTS codes and the SPARCS ICD-9-CM codes are compared to evaluate performance of the incident reporting. The two database systems do not always agree, and NYPORTS provides information on Selected Codes that are useful in the proper identification of ‘incidents.’
The New York Department of Health has expressed a strong sentiment of extensive under-reporting of ‘incidents’ to the NYPORTS. The efforts to standardize reporting reinforce NY Health Department attempts to minimize ambiguity in event definitions so as to fascilitate identification of patients with reportable events. What also is implicit in the NY system is that the identification of patients with reportable events is in the hands of medical coders and not in the hands of physicians or other health providers.