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Medical Errors and Patient Safety

Facility Participation

  • •  Participation in NYPORTS Adverse Event Reporting

    Participation is mandatory for “hospitals.” As defined in NY PBH § 2801.1,

    "Hospital means a facility or institution engaged principally in providing services by or under the supervision of a physician or, in the case of a dental clinic or dental dispensary, of a dentist, for the prevention, diagnosis or treatment of human disease, pain, injury, deformity or physical condition, including, but not limited to, a general hospital, public health center, diagnostic center, treatment center, dental clinic, dental dispensary, rehabilitation center other than a facility used solely for vocational rehabilitation, nursing home, tuberculosis hospital, chronic disease hospital, maternity hospital, lying-in-asylum, out-patient department, out-patient lodge, dispensary and a laboratory or central service facility serving one or more such institutions, but the term hospital shall not include an institution, sanitarium or other facility engaged principally in providing services for the prevention, diagnosis or treatment of mental disability and which is subject to the powers of visitation, examination, inspection and investigation of the department of mental hygiene except for those distinct parts of such a facility which provide hospital service. The provisions of this article shall not apply to a facility or institution engaged principally in providing services by or under the supervision of the bona fide members and adherents of a recognized religious organization whose teachings include reliance on spiritual means through prayer alone for healing in the practice of the religion of such organization and where services are provided in accordance with those teachings. "

    "General hospital" means a hospital engaged in providing medical or medical and surgical services primarily to in-patients by or under the supervision of a physician on a twenty-four hour basis with provisions for admission or treatment of persons in need of emergency care and with an organized medical staff and nursing service, including facilities providing services relating to particular diseases, injuries, conditions or deformities. The term general hospital shall not include a residential health care facility, public health center, diagnostic center, treatment center, out-patient lodge, dispensary and laboratory or central service facility serving more than one institution."

    Based on these "hospital" definitions, it is clear that there is sufficient lattitude so as to include most facilities with physician-directed or dentist-directed healthcare in the reporting requirements. These clinics might include all physicians offices and/or larger group practices. However, according a 2003 audit of NYPORTS performed by the State Comptroller, "Maintaining Information on Adverse Patient Incidents at Hospitals and Clinics, 2003-S-27" [PDF]

    "An occurrence is defined as an unintended adverse and undesirable development in an individual patient's condition, such as death or impairment of bodily functions in circumstances other than those related to the natural course of illness, disease or proper treatment. Occurrences, which must be reported by a total of 263 hospitals and approximately 1,350 clinics, are classified by the Department as most serious or less serious. All occurrences classified as most serious must be investigated by the medical facility, and an investigation report identifying the cause of the occurrence must be submitted by the facility and entered onto the NYPORTS database."

    There are obviously far more than 1,350 provider offices throughout New York, so it is clear that the NYSDOH does not pursue reporting from all physician-directed healthcare facilities. Although the NYSDOH expects reporting from diagnostic and treatment center clinics, It is not clear why some physician clinics qualify for reporting and why some do not.

    This issue has very little relevance based on experience, since the 2003 NYPORTS audit indicated that less than 1% of all events were contributed by clinics, and there was evidence that some of the clinic data was never entered, even when it was provided to the NYSDOH offices. Noteworthy is that general hospitals enter information directly into the NYPORTS system through a statewide computer network: health clinics do not have access to this network, so they report information to DOH field offices where it is then entered into NYPORTS.

    Based on the definition of "hospital", psychiatric hospitals are excluded from incidence reporting requirements.

    Ambulatory surgery centers and other centers providing short-term or out-patient care are not included in the NYPORTS reporting requirement. The freestanding diagnostic and treatment centers, including ambulatory surgery centers, report a limited list of incidents to the New York State Department of Health (NYSDOH) by regulation, (e.g., patient deaths or transfers to hospitals). NYPORTS adverse event reporting does not cover long-term care (e.g., nursing homes, hospices), private medical practices, retail pharmacies, and home care.

  • •  Participation in Statewide Planning and Research Cooperative System (SPARCS)

    All hospitals and ambulatory surgery centers are required since 1979 to provide administrative data to the SPARCS program, as authorized by Department of Health Regulations [10 NY CCR, §400.18] The Department of Health has provided a Universal Data Set specification which includes reporting codes for use with the UB-92 billing forms. These reported data are currently used by the Niagara Health Quality Coalition that has begun to provide report cards of all New York Hospitals according to AHRQ's Inpatient Quality Indicators.

  • •  Participation in Mandatory Cardiac Outcome Reporting

    Cardiac procedure reporting is required by 45 of New York's 273 hospitals that perform either Percutaneous Coronary Interventions (PCIIs), aka angioplasties or PTCAs, or cardiac surgical procedures, including valve surgeries and coronary artery bypass procedures.

    In 1974, the NYS Cardiac Advisory Committee (CAC) was formally instituted by the Commisisoner of DPH. In an effort to improve upon existing aggregate data and as a sytem for Quality Improvment, in the early 1990s this group authorized the development of the Cardiac Surgery reporting System (CSRS). The data is reported in a database format to the DOH, which checks for authenticity against SPARCS administrative data. Risk-adjustment models of mortality have been developed under the direction of the Cardiac Advisory Committee. Public reporting of 1992-1994 New York CABG surgery data began in 1996, but cardiac data back to 1989 has been evaluated by the mortality risk-adjustment model. All 37 cardiac hospitals in New York performing CABG and/or valve surgery and the 45 hospitals performing Percutaneous Coronary Angioplasties are required to report under authority of 10 NYCRR Section 405.22 (Critical care and special care services). These regulations stipulate that the CAC,

    “. . . at the request of the commissioner, shall consider any matter relating to cardiac diagnostic centers [and cardiac surgical centers] and shall advise the commissioner thereon.”

    These same regulations provide control of organ transplantation and burn units/centers.

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