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Washington State adopts reporting requirements and public disclosure of hospital infection rates

One can tell fairly quickly which special interests dominate in state government by the state's response to public data and trends.  In the past few months, two major studies have confirmed the frequency with which patients suffer preventable, negligent harm while hospitalized.  (What a surprise, there are occasional mistakes in the country's major industry and not every health care provider is perfect all the time.)  One study of regional hospital charts confirmed that one in seven hospitalized Medicare patients was injured during October of 2008; while a more recent study published in the prestigious New England Journal of Medicine documented that 18 percent of more than 2,000 hospitalized patients' charts identified a preventable injury.  Both studies confirm the findings of a landmark 1999 study suggesting that hospital errors cause as many as 98,000 preventable deaths each year in the United States.  While many of the errors identified were relatively minor, one-half resulted in additional hospital days of care, and about two percent were fatal.

One of the  primary sources of preventable hospital injuries (or of "never-events" as the most serious problems are termed) is hospital--or "nosocomial"--infection.  Published work by the University of Michigan and Johns Hopkins University has recently demonstrated that the rate of infection in all hospitals, large and small, can be dramatically reduced by adherence to a simple checklist similar to an airline pilot's pre-flight. 

In response to this and similar research, in 2007 the State of Washington adopted rules that require hospitals to report, for public disclosure, their rate of infection and whether they follow the guidelines promulgated in response to the research studies by Johns Hopkins University and the University of Michigan.  Now, patients in Washington (and admitting doctors) can "vote with their feet" to support hospitals that fight for lower infection rates.  Washington medical care providers have confirmed that this disclosure has amplified the pressure to achieve lower nosocomial infection rates and has been effective.

Similarly, the state of California has adopted rules requiring hospitals to report (to it, not to the patient's family) errors that endanger a patient's life.  In the past three years, about twenty percent of hospitals have failed to report a single such event, but among the hospitals in compliance, more than 1,000 events have been recorded. 

Other states, like Illinois and Michigan, take a different approach.  In response to "fierce" opposition from the Illinois Medical Association, Illinois recently repudiated its plan to require disclosure of individual physicians' histories of sexual misconduct, loss of privileges or malpractice payments.  Michigan's legislature is currently considering a bill that would grant immunity to all health care providers who treat patients admitted through a hospital's emergency room.  We have no rules addressing public disclosure or encouraging patient safety or information:  we just brush inconvenient matters "under the rug."  Or "bury them."

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