Ten years ago, the Institute of Medicine called for mandatory reporting of medical events that result in death or serious harm, and voluntary reporting of near misses and minor injuries. The intent of reporting these events is to use the data to guide improvements.
The National Quality Forum held a meeting in October, 2009 with reporting officials from more than 20 states to find out what has been accomplished and what opportunities still exist.
Currently, 27 states and the District of Columbia have reporting systems to help identify and learn from medical errors. It was found that despite the fact that many of these systems include some or all of NQF’s list of 28 Serious Reportable Events, significant differences exist among the systems and approaches. There remain many opportunities for strengthening state and federal coordination for reporting adverse events as well as sharing best practices and improvements.
(Source: NQF Quality Connections: The Power of Safety; http://www.qualityforum.org, June, 2010)