Calif. Hospitals Reported 6,282 Adverse Events Over Four Years
In the last four fiscal years, California hospitals have reported more than 6,000 adverse events to the California Department of Public Health, but the number of actual adverse events could be higher, according to an NBC Bay Area investigative report.
As many as 400,000 U.S. residents die annually from adverse events at hospitals, according to a study published last year in the Journal of Patient Safety.
Under California law, hospitals are required to report adverse events to DPH, which publishes them in an annual report. Hospital names, dates that the events occurred and fines are not revealed in the report. According to NBC Bay Area, DPH conducts on-site inspections in response to hospitals reporting adverse events.
Details of Investigative Report
NBC Bay Area's analysis was based on public records requested from DPH.
Researchers found 6,282 reported adverse events in the last four fiscal years among the 410 California hospitals in the DPH database.
In California, the most highly reported adverse events were:
- Bedsores, with 3,959 reported cases; and
- "Retention of a foreign object in a patient," with 986 reported cases.
According to the data, Stanford Medical Center and the UC-San Francisco Medical Center reported the most adverse events, of which the majority were bedsores.
Further, the data show that in California:
- Arrowhead Regional Medical Center in San Bernardino County reported 32 cases of death or serious disability caused by bed rails or restraints, the most reported cases in the category;
- Feather River Hospital reported 10 cases of "performing the wrong surgical procedure," the most reported cases of that type of event; and
- Santa Clara Valley Medical Center reported 30 cases of "retention of a foreign object" during surgery, the most reported cases of that type of event.
According to the data, 197 hospitals in the state reported five or fewer mistakes over the four-year timeframe.
However, some experts say the number of medical errors could be higher, as DPH cannot ensure that all hospitals report every adverse event, according to NBC Bay Area.
Several hospitals said that high numbers of adverse event reports can result from treating sicker patients.
Stanford Medical Center in a statement said, "Stanford Health Care treats some of the sickest patients in the nation, many of whom have much more complex medical conditions than typically seen at community hospitals."
Meanwhile, Josh Adler -- chief medical officer at UCSF -- said the medical center's high numbers are the result of dedication to tracking and reporting every error that occurs. He said, "I can't emphasize enough how challenging it is to actually count and monitor and know when those things are happening," adding, "I believe we are a very safe hospital and part of the reason we are safe is that we have been in the error-finding and resolving business for a long time. We are dedicated to finding all our errors if we can, and then reporting them" (Stock et al., NBC Bay Area, 11/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.