They Are Our Patients and Our Data

Rahul K. Shah, MD, George Washington University School of Medicine, Children’s National Medical Center, Washington, DC There are myriad databases reporting on a physician’s outcomes, or a surgeon’s complications, your partner’s length of stay, and many other types of data being collected by societies, institutions, government, and commercial insurers, just to name a few. However, many of these databases and the data are not owned by the patients or the physicians that care for the patients. Hospitals, and in some cases, practices, submit data, often times mandatory, that is then collated and put together in aggregate. From there, the data is compiled at a national level to make meaningful analysis statistically significant. We are excited to soon launch a patient safety event web portal on the AAO-HNS website. This is the end result of an attempt to develop a mechanism where we can have our physicians securely and confidentially report on near misses, adverse events, and medical errors. The original idea was to consider forming an otolaryngology-specific Patient Safety Organization (PSO) that would serve such a role. There are significant administrative burdens to forming PSOs, and the investment did not appear to provide real value to members. Under the guidance the AAO-HNS quality improvement staff, the Patient Safety and Quality Improvement Committee has created a secure patient safety event web portal that enables physician members to enter events. Academy staff have gone to great lengths to ensure the protection of the reporting physician’s information and the subsequent report. Furthermore, none of the fields in the reporting form allow for identification of a particular patient, location, venue, etc. It is exciting to consider the potential of an event reporting database. The Federal Aviation Administration has the most robust reporting system where pilots and crew are mandated to complete such a report when specific events occur. No such system exists in healthcare or our specialty. The power of some aggregate level data cannot be over-emphasized. The rare frequency of events that we are looking at may only happen in 1:30,000 instances, or less. An individual practitioner, for example, may have heard and known about a case of misadministration of concentrated epinephrine, but they may not have personally ever experienced such an occurrence. Does this make the problem less of a latent systems defect? Of course not. It just makes it much harder for physicians to see the magnitude and the scope of the issue.1 This is precisely where the reporting system becomes valuable. By surgeons reporting events that are of concern to them, we will have the ability to immediately identify zones of risk. Once these areas are identified, we can proactively study them to attempt to put measures in place to assist in mitigating future events. The major caveat of this platform is that the data is only as good as the input. For example, if we have 1,000 reports (one per every four physician members) in our first year, we are confident that there would be actionable alerts and possibly interventions that would come from these reports. However, we do fear that if there are only five reports all year, then the database becomes meaningless. This is our opportunity to report on instances of near misses, adverse events, and medical errors that directly influence our practice and our patients. Rarely do we have such an ability to affect the safety and quality of the care provided to our patients. We look forward to periodically sharing the data with members. References Shah RK, Hoy E, Roberson DW, Nielsen D. Errors with Concentrated Epinephrine in Otolaryngology. Laryngoscope. 2008 Nov;118(11):1928-30. We encourage members to write us with any topic of interest. We will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.