The Pennsylvania Patient Safety Authority
The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act, to help reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety. Under the Act, all Pennsylvania-licensed hospitals, ambulatory surgical facilities (outpatient surgery centers), birthing centers and certain abortion facilities are required to report “Serious Events” and “Incidents” to the Authority. More than 500 healthcare facilities are subject to Act 13 reporting requirements. While the public does not report to the Authority, if you have a complaint against a healthcare facility or healthcare professional more information is listed below.
How and Why Do Facilities Report?
Patient Safety Officers in healthcare facilities submit reports of Serious Events and Incidents through the Pennsylvania Patient Safety Reporting System (PA-PSRS), a confidential web-based system. More than one million reports have been submitted through PA-PSRS since the program was initiated in June 2004. Ninety-six percent of these reports are Incidents (events that do not cause harm to the patient), while four percent are Serious Events (events that harm the patient). The Authority develops and distributes Patient Safety Advisories and other related resources for facilities to learn from the data they have submitted. Over 170 articles have been distributed through the Patient Safety Advisories. Patient Safety Officers surveyed in 2008 found the Advisories useful (98%), relevant (97%) and readable (99%), high in scientific quality (97%) and high in educational value (99%). Surveyed PSOs also said they made over 600 changes in their facilities as a result of specific information in Patient Safety Advisory articles in 2008.
Act 13 Definitions of a Serious Event and Incident:
Serious Event (Causes harm to the patient)
An event, occurrence or situation involving the clinical care of a patient in a medical facility that results in death or compromises patient safety and results in an unanticipated injury requiring the delivery of additional health care services to the patient. A patient or their representative should receive written notice from their healthcare provider if a Serious Event occurred to him/her during their hospital stay.
Incident (Does not cause harm to the patient)
An event, occurrence or situation involving the clinical care of a patient in a medical facility which could have injured the patient but did not either cause an unanticipated injury or require delivery of additional health care services to the patient.
What You Should Do If You Have A Complaint:
Talk with the facility’s patient advocate or guest relations office as soon as possible. Do not be afraid to speak openly and honestly about your concerns regarding your care. Facilities that want to improve patient safety welcome feedback from patients in regard to their care.
If you are not satisfied with the outcome of your discussions after filing a complaint internally with the healthcare facility, the following anonymous hotline numbers are available: For complaints against a healthcare facility, please contact the Department of Health at 1-800-254-5164. For complaints against a licensed healthcare professional please contact the Department of State’s Bureau of Professional and Occupational Affairs at 1-800-822-2113.
For more information on the Pennsylvania Patient Safety Authority go to www.patientsafetyauthority.org.