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medical errorState Measure Errors In Connecticut Hospitals

HARTFORD: Good news from the Connecticut Department of Public Health, errors or what they call “adverse events” in hospitals and ambulatory surgical centers were down in 2015.

There were however 465 such adverse events and according to the data mostly occur [85%] within four medical treatment areas. (1) stage 3-4 or unstageable pressure ulcers acquired after admission to a healthcare facility, (2) falls resulting in serious disability or death, (3) perforations during open, laparoscopic, and/or endoscopic procedures, and (4) retention of foreign objects in patients after surgery.  

Fifty-two percent of reported adverse events occurred in males and 48% in females. The majority of reports [56.8%] concerned patients over the age of 65 years, but a full 40% were patients 15-64.

The most commonly reported events in 2015 were pressure ulcers, with 230 pressure ulcers comprising 50% of all 456 adverse events reported. The second most commonly reported events were falls resulting in death or serious injury, with 90 reports (20%). Perforations during open, laparoscopic, and or endoscopic procedures, followed with 49 events (11%). 

While some might understand a “slip of the scope” some errors may be a little harder to accept for some.

Foreign objects were left inside patients after surgery or other procedures 19 times. Surgery on the wrong location occurred 13 times and in one case the wrong patient.

The rate of perforations was down 38% from a high of 79 in 2013 but 49 patients were “seriously injured or died during, laparoscopic and/or endoscopic procedures.

Yale New Haven Hospital with 76 “adverse events” was among the least error prone of the hospitals, based on the number of patient days, a total of 411,361 in 2015. YNHH had 18.5 adverse effects per 100,000 days but they were edged out by Hartford Hospital with only 16.4% against a total of 225,885 days.