Adverse event reporting: lessons learned from 4 years of Florida office data.
BACKGROUND
Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting.


OBJECTIVE
To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004.


METHODS
We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches.


RESULTS
Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer.


CONCLUSIONS
Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths.
Coldiron
Brett
B
The Skin Cancer Center, Cincinnati, Ohio, USA.
Fisher
Ann Harriott
AH
Adelman
Eric
E
Yelverton
Christopher B
CB
Balkrishnan
Rajesh
R
Feldman
Marc A
MA
Feldman
Steven R
SR
D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D000758:Anesthesia / Q000009:adverse effects / Q000706:statistics & numerical data; D003406:Credentialing; D005431:Florida / Q000453:epidemiology; D006801:Humans; D019221:Mandatory Reporting; D010824:Physicians' Offices / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D017751:Safety Management / Q000706:statistics & numerical data*