UNMC News

Nebraska Coalition for Patient Safety helps hospitals learn from their mistakes

Half of Nebraska's hospitals have joined coalition; member hospitals and board members listed

When choosing a health care facility, the executive director of the Nebraska Coalition for Patient Safety said potential patients should add one more query to their list of questions: “Do you self-report adverse events?”

And if the answer is “no,” Ann McGowan said, maybe you should consider getting your knee replacement – or whatever it may be – somewhere else.

NCPS is an independent, nonprofit, federally-designated patient safety organization (PSO), founded by the Nebraska Academy of Physician Assistants, Nebraska Hospital Association, Nebraska Medical Association, Nebraska Nurses Association and Nebraska Pharmacists Association. It is headquartered at the University of Nebraska Medical Center’s School of Allied Health Professions.

Its aim is to create a culture of safety in Nebraska health care by encouraging, assisting and collaborating in the self-reporting of medical errors and patient-safety events by health care organizations across the state. The reports are then studied, and de-identified and shared across NCPS membership, in hope of avoiding a repeat of similar incidents.

“By sharing this information with others, hospitals can learn to prevent errors before they happen,” said Stephen Smith, M.D., NCPS president and chief medical officer at The Nebraska Medical Center.

According to its 2012 annual report, NCPS has trained more than 250 professionals from 59 health care organizations in the use of root-cause analysis – a tool to analyze and learn from adverse events.

Half of Nebraska’s hospitals have joined the coalition – but half have not. It’s tough to crack the culture of keeping our mistakes to ourselves, said Darwin Brown, assistant professor in UNMC’s physician assistant education program, who serves as NCPS treasurer.

But those incidents are happening, whether the public hears about them or not. A 2008 U.S. Department of Health and Human Services report found that 13.5 percent of Medicare beneficiaries surveyed experienced a serious adverse event during their hospital stay. An additional 13.5 percent experienced smaller events which resulted in temporary harm.

If we hear of an incident, we may be less apt to use that hospital. “But I tend to think the opposite,” McGowan said. “It means they’re engaged. They know what’s going on.”

We all make mistakes – even health care organizations.

There’s only one way to find out if a health care organization is learning from its mistakes, McGowan said: Ask.

For more information on NCPS, or to speak with McGowan, call 402-559-8421 or go to www.nepatientsafety.org.

NEBRASKA COALITION FOR PATIENT SAFETY – MEMBER HOSPITALS

Albion -- Boone County Health Center

Alliance -- Box Butte General Hospital

Alma -- Harlan County Health System

Atkinson -- West Holt Medical Services

Auburn -- Nemaha County Hospital

Aurora -- Memorial Community Health

Beatrice -- Beatrice Community Hospital

Cambridge -- Tri Valley Health System

Central City -- Litzenburg Memorial County Hospital

Columbus -- Columbus Community Hospital

Cozad -- Cozad Community Hospital

Creighton -- Avera Creighton Hospital

David City -- Butler County Health Care Center

Fairbury -- Jefferson Community Health Center

Fremont -- Fremont Area Medical Center

Geneva -- Fillmore County Hospital

Grand Island -- St. Francis Medical Center

Holdrege -- Phelps Memorial Health Center

Kearney -- Good Samaritan Hospital

Lexington -- Lexington Regional Health Center

Lincoln -- Nebraska Heart Hospital; Bryan Health; St. Elizabeth Regional Medical Center

McCook -- Community Hospital

Nebraska City -- St. Mary’s Community Hospital

Neligh -- Antelope Memorial Hospital

Norfolk -- Faith Regional Health Services

North Platte -- Great Plains Regional Medical Center

Omaha -- Alegent Health Bergan Mercy Medical Center; Alegent Health Immanuel Medical Center; Alegent Health Lakeside; Creighton University Medical Center; Nebraska Methodist Health System; Nebraska Orthopaedic Hospital; The Nebraska Medical Center

O’Neill -- Avera St. Anthony’s Hospital

Osmond -- Osmond General Hospital

Papillion -- Alegent Health Midlands Hospital

Pawnee City -- Pawnee County Memorial Hospital

Pender -- Pender Community Hospital

Schuyler -- Alegent Health Memorial Hospital

Seward -- Memorial Health Care Systems

St. Paul -- Howard County Medical Center

Superior -- Brodstone Memorial Hospital

Tilden -- Tilden Community Hospital

Valentine -- Cherry County Hospital

Wahoo -- Saunders Medical Center

Wayne -- Providence Medical Center

West Point -- St. Francis Memorial Hospital

NEBRASKA COALITION FOR PATIENT SAFETY – BOARD MEMBERS

Officers (all from Omaha):

President -- Stephen B. Smith, M.D., The Nebraska Medical Center

Vice president -- Katherine Jones, Ph.D., University of Nebraska Medical Center (UNMC)

Treasurer -- Darwin Brown, UNMC physician assistant

Secretary -- Patty Scholting, UNMC physician assistant

Other board members:

Columbus -- Dan Rosenquist, M.D., Columbus Family Practice Association

David City -- Don Naiberk, Butler County Health Care Center

Grand Island -- Paula Riesberg, St. Francis Medical Center

Lincoln -- Kathy Corbett, Nebraska Wesleyan University; Doug Elting, Visions in Architecture; Cary Ward, M.D., St. Elizabeth Regional Medical Center

Norfolk -- Laura Hoogestraat, Faith Regional Health Services

Omaha -- Ed DeSimone, Ph.D., Creighton University Medical Center

West Point -- Carol Kampschneider, St. Francis Memorial Hospital

 

Contact

Tom O'Connor
UNMC Public Relations
(402) 559-4690 (office)
(402) 650-7063 (cell)
toconnor@unmc.edu

Kalani Simpson
UNMC Public Relations
(402) 559-7847
(402) 968-7726
kalani.simpson@unmc.edu