Nonprofits, schools to vie for patient safety center

Facility would analyze medical mistakes

November 30, 2003|By Julie Bell | Julie Bell,SUN STAFF

Maryland doesn't have any money for an initiative it considers a "centerpiece" of efforts to keep health care facilities from harming patients, but it's trying an unusual plan to go ahead anyway.

On Tuesday, the Maryland Health Care Commission plans to open bids from nonprofit groups and academic institutions vying to operate a statewide center that would analyze medical errors and other incidents that hurt patients or barely miss doing so.

Instead of money, the winning bidder will get the right to call itself the Maryland Patient Safety Center.

"Anyone who submits a bid to us has to demonstrate that they can adequately fund the ... center for three years," said Barbara McLean, the commission's executive director. "It may be that Dec. 2 comes and we won't see a single proposal. I don't know."

Still, she said she's optimistic after a handful of potential bidders ---including the Maryland Hospital Association, the Delmarva Foundation, the University of Maryland School of Medicine and a representative from a key Johns Hopkins University patient safety group -- attended a recent pre-bid conference.

The center is part of a multipronged approach designed to improve patient safety in Maryland. Its job: to gather voluntary reports from health care facilities about events that harmed or nearly harmed patients, analyze them and teach how to avoid them.

The commission wants hospitals and nursing homes to report incidents large and small, ranging from a misplaced note about a patient's drug allergy to infections that health care workers accidentally spread. Eventually, the center would urge outpatient surgery facilities and other providers to report problems, too.

Consumer advocates have been pressing for such patient safety efforts since the nonprofit Institute of Medicine estimated in November 1999 that medical errors kill as many as 98,000 hospital patients a year in the United States.

Beginning Jan. 1, in an effort separate from the patient safety center, Maryland will require hospitals to tell regulators about the most serious adverse events, including those caused by accidents and medical errors. But the mandatory reports cover only events that result in a patient's death or serious disability.

Some patient-safety experts argue that it would be more effective if hospitals report all adverse events, no matter how serious, as well as "near-misses" -- situations that nearly resulted in harm but didn't.

What's more, some argue that health care workers are more likely to report such events if they can do so voluntarily and anonymously, avoiding the punishment that can come with reporting to regulators.

"Mandatory reporting hasn't improved patient safety all that much," said Dr. Peter Pronovost, a Johns Hopkins Hospital patient-safety and critical-care expert. "The concept is, we need to learn what's broken."

Under the voluntary system to be used by the center, health care facilities would send "de-identified" information. That means the patient safety center wouldn't be able to identify the health care workers -- or perhaps even the hospital -- involved, McLean said.

The General Assembly has also made the center's records off-limits to lawyers who want information for potential lawsuits on behalf of injured patients.

That provision might help persuade hospitals, which traditionally have shied away from reporting adverse events for fear that they would spur more lawsuits, to participate. But the state will still have to overcome other concerns, such as whether reporting will be worth hospitals' time and expense.

"That is something we work on all the time, trying to make it important enough to providers," said Robin Wolfgang, a spokeswoman for the Delmarva Foundation, a nonprofit group that works on patient-safety issues. Wolfgang said one way to encourage hospitals is to show them that improving patient safety helps the hospital's bottom line.

The first order of business for the Health Care Commission, however, is finding a contractor willing to plan and operate the patient safety center, even without any state or guaranteed grant money.

Among other things, the contractor would have to identify how it would collect the information and what software it would use to analyze the data. It would also have to set up an advisory board to develop patient-safety priorities based on the information the center gathers.

The center's advisory board -- which would have representatives from hospitals, nursing homes, the Maryland Hospital Association and other interests -- would also have to devise a plan for teaching better practices to health care workers.

The United States Pharmacopeia -- a nonprofit group that operates a national anonymous medication-error reporting system -- sent a representative to an Oct. 23 pre-bid conference about the center but has decided not to bid.

"I understand state or federal funding was not part of the process, and for us that was a big disincentive," USP spokeswoman Sherrie Borden said.

But McLean said she hopes to receive proposals from other nonprofit or academic institutions -- the types of organizations eligible to bid. The Maryland Hospital Association declined to comment, and a Johns Hopkins patient-safety researcher who attended the Oct. 23 meeting could not be reached.

Wolfgang, the Delmarva spokeswoman, stopped short of confirming that her foundation would submit a proposal. But she the lack of state money is "not a disincentive. The issue is important enough to us. We would be willing to participate in the endeavor even if there is no money."

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