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Hospital mistakes must be disclosed Accreditation at risk if patients aren't told

By Robert Davis
USA TODAY

Hospitals must now tell patients and their families when they have been hurt by a medical error, according to nationwide standards that take effect Sunday.

The standards by the nation's leading health care accrediting agency are the first to hold hospitals accountable for a higher level of patient safety.

As many as 98,000 people die each year from medical errors, according to the Institute of Medicine. The medical community is scrambling to try to make health care safer, but the effort has been hampered partly because of the way that errors are handled.

When a mistake is made today, there is no legal requirement that a patient be told. The result is that those close to the error know of the mistake, but the event is kept secret.

Left hidden, common medical mistakes -- such as administering a drug incorrectly -- are rarely identified quickly and studied for ways to make the health care system safer, researchers say.

''These standards are meant to create a culture of safety,'' says Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a non-profit group that accredits 80% of the nation's hospitals. He announces the standards today. ''Errors are not reported inside organizations because caregivers are fearful they will be punished.''

The new standards are designed to promote open discussion and review of errors so that fixes can be found and applied, O'Leary says. A hospital could get in more trouble for not looking for errors than by committing them. ''If we can save a lot of lives by making some basic changes in patient care processes, it will be a wonderful benefit,'' he says.

The new standards, available at www.jcaho.org, do not require new hospital bureaucracies. JCAHO simply demands that hospital leaders tackle medical errors and patient safety -- or risk losing accreditation.

During regular hospital inspections, the commission now will look for patient safety compliance from hospital CEOs to patients.

Each hospital in the USA must: Actively work to prevent errors; design patient safety systems, such as systems that double-check a drug order before a prescription is filled; and encourage and act on internal reports of errors.

The JCAHO calls a medical error ''an unintended act, either of omission or commission, or an act that does not achieve its intended outcome.''

The American Medical Association, which has an ethical standard that says doctors should always tell patients about medical errors, applauds the commission's new standards.

''Safety has to start with the leadership of an organization,'' says the AMA's Donald Palmisano, a surgeon in New Orleans. ''That is what JCAHO is doing here.''

The American Hospital Association agrees. ''We are very supportive,'' the association's Don Nielsen says.

The new standards should not cost hospitals anything to implement, he says.

O'Leary says that ''to create a culture of safety, caregivers must feel safe that they are not going to be punished and that the system is designed to protect them when they do make a human error.''