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– TENNESSEE –
Public and Private Policy
Medical Errors and Patient Safety

Definitions

According to the Health Data Reporting Act of 2002, an “unusual event” is the central event that is mandated for reporting. In T.C.A. §68-11-211(c)(7), an

“unusual event is an unexpected occurrence or accident resulting in death or life-threatening or serious injury to a patient that is not related to a natural course of the patient's illness or underlying condition. An unusual event also includes an incident resulting in the abuse of a patient.”

Although not included in statute, the Department of Health task force in 2002 provided further interpretive guidelines [PDF, p6] by defining “serious injury” or “life-threatening” for guidance in determining what needs to be reported:

Serious injury” or “life-threatening” requires the patient to undergo significant additional diagnostic or treatment measures.

The Department of Health task force was the key group in providing guidelines to the legislature for what reported events should appear in the statute. Compared to other states with adverse event reporting programs, Tennessee stipulates the longest list of reportable events, i.e. “unusual events” [T.C.A. §68-11-211(d)(2)]. (New York actually reports a greater number, but they are not defined in law.)

It would appear that many of the JCAHO reviewable sentinel events” and the NQF's 27 ‘Serious Reportable Events in Health Care’ are included in the Tennessee list. However, the list extends beyond the JCAHO and NQF list of reportable events. Furthermore, there are some definition differences among Tennessee, JCAHO, and NQF defined events, as can be seen by comparing definitions across programs.

In T.C.A. §68-11-211(d)(2)(I) are listed 22 distinct events that occur following procedures, some of which may or may not be related to procedures (e.g. elopement, rape, etc.) and some of which (e.g., hemorrhage and wound infection) reflect events that are known to occur even in the context of excellent health care and outside the context of ‘adverse events.’, (according to the IOM definition – “events that occur as a result of medical management’). In this context, it is apparent that some reported “unusual events” that reflect procedure-specific performance measures, as opposed to medical errors, are also monitored in Tennessee. It is noteworthy that New York's NYPORTS also acknowledges monitoring of adverse events in the 1999, Executive Summary.

Tennessee's reporting events are very similar to those in New York. Similar to New York's NYPORTS system, Tennessee has gone to great lengths to provide definitions that are clear and concise by use of ‘Occurrence Codes’ and ‘Includes/Excludes’ lists. Tennessee extends the definitions and ties those definitions to mutually understandable expectations for the Department of Health and for all health care facilities.

As part of the implementation and validation process, Tennessee developed and provides the “Interpretive Guidelines for Reporting Unusual Events” [PDF]. This impressive reference provides interpretive guidelines based on work performed by the Department of Health task force, which was instrumental in designating ‘Occurrence Codes’ and developing the ‘Includes/Excludes’ lists (similar to those used in NYPORTS) for use by surveyors and health care facilities.

For example, codes that automatically trigger a visit from the Department of health include any unusual event associated with a complaint and all deaths of reportable unusual events. These and other codes are utilized to develop guidelines for Department of Health investigations and visitations, as provided by the Department of Health table. It is apparent that Tennessee's electronic reporting program required a lot of development time and education in order to translate statute-defined definitions into results that are readily evaluated and interpretable. The reporting system, while designed to simplify and clarify reporting by each definition, is technically-sophisticated and likely requires on-going training for new personnel and for smaller facilties that report very infrequently. It represents an ambitious state-of-the-art effort for translating definitions into reportable information.

Tennessee Definitions of Unusual Events are available for perusal in the ‘Includes/Excludes’ format that reflects the changes listed in the updated 2005 Guidelines [PDF].

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