Nova Scotia Medical Errors Registry a Step in the Right Direction: Still a Long Way to go

by John McKiggan

Last week Nova Scotia released the result of its new policy which requires hospitals to report adverse events (medical speak for errors or mistakes).

According to the Province in the last six month there were 27 separate incidents, 21 of which where an “adverse event” led to serious disability or death.

Step in the right direction

I give the Province credit for moving forward with the Adverse Events Registry. Any effort to improve transparency in health care is something I support. Ultimately improve transparency will lead to more accountability and better patient safety and health care.

More work needed

However, as a stands now the registry is still a work in progress and has a long way to go before it will help fulfil its role in improving patient safety.

As I have written before, there are no national standards for disclosure of medical errors.

Almost ten years ago the Canadian Patient Safety Institute called for national guidelines for the disclosure of adverse events. After two years of study and consultation with the various provincial and national medical and health organizations CPSI released draft national guidelines for the disclosure of adverse events.

It was interesting that the overwhelming majority of organizations consulted (81%) claimed to have developed a policy of procedure requiring disclosure of adverse events. But the most concerning discovery was that more than half of the survey respondents (53%) said that there was no training (or they did not know if training was offered) regarding what constitutes an adverse event and how the information is to be reported.

Medical malpractice kills more than 24,000 Canadians each year. Even more people are left with serious injury or disability.

Health care workers are overworked and understaffed. The average age of Canadian nurses and doctors is getting closer and closer to retirement. Problems with understaffing are only going to increase as large numbers of medical professionals leave the health care field.

Problems with the Nova Scotia registry

Some of the problems with the Nova Scotia’s Adverse Events Registry are as follows:

1. There are no sanctions for failure to report;

2. There does not appear to be any training program for health care staff associated with the registry to help staff identify what constitutes an adverse event and how the information should be reported;

3. The registry relies on hospitals to report the medical errors to the registry. However, if hospital staff do not report the error to the hospital the hospital cannot pass on the information to the registry. There is no method for patients to report medical errors to the registry;

4. One of the biggest flaws is that fact that if a hospital denies that they made a mistake than they are not required to report the incident to the registry. For example, in just about every medical malpractice lawsuit the doctor, nurses or hospital deny that a mistake was made;

5. No reporting of complication rates: Hospitals keep track of surgeon’s complication rates after surgery. If a particular surgeon has a much higher rate of complications after surgery than his or her colleagues, that information should be considered and reported to the Adverse Events Registry;

6. Some types of adverse events are not included in the registry. For example, hospital acquired infections can cause serious injury or death and are a common occurrence in many hospitals across Canada and in Nova Scotia in particular. Yet the medical registry does not require hospitals to report the number of patients who end up suffering from, or dying from, hospital acquired infections;

7. The registry does not provide particulars of the nature of the adverse event;

8. The registry does not provide any information about what, if any, steps were taken to address the adverse event and any errors that may have caused the problem.

A first step

Nova Scotia Adverse Events Registry is a first step in the right direction. However, there is still improvements necessary before the registry will fulfil its goal of improving patient safety and health care for Nova Scotians. Here is hoping that the Registry won’t end up being windowdressing rather than a real attempt to improve patient care and safety.

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