Faribault’s District One Hospital had no adverse health events in 2013

Faribault’s District One Hospital officials were pleased not to be listed in the Minnesota Department of Health’s Adverse Health Events in Minnesota report in 2013 after recording one adverse event in 2012.


District One officials want to put the adverse health event documented by the MDH in 2012 — a foreign object left in a patient after surgery — behind them and work to remain out of the report in future years.

“District One Hospital proudly participates in patient safety initiatives aimed at reducing patient falls, pressure ulcers, retained objects, wrong site procedures, adverse drug events, readmissions, healthcare-acquired infections, and providing a culture of safety,” said chief operating officer Joan Boysen. “We continually strive to enhance patient safety and participate in dozens of safety initiatives through the Minnesota Hospital Association, Stratis Health and other organizations.”

Boysen said that among other safety awards, District One Hospital received the Partnership for Patients Excellence Award for reaching a superior level of performance in patient safety in 2013. The statewide goal of this initiative is to achieve a 40 percent decrease in healthcare-acquired conditions and a 20 percent decrease in readmissions.

“A strong safety culture within our hospitals is the foundation of patient safety and quality improvement efforts,” Boysen said. “Our hospital staff are encouraged to report any potentially unsafe situation, and should feel comfortable doing so.”

Since 2005, the only other time besides 2012 that District One Hospital has had an adverse event in the report was in 2008, when a wrong surgical/other invasive procedure was performed.

According to the report, there were 14,510 surgeries/invasive procedures performed at District One in 2012. In 2008, the number of surgeries performed was 2,590.

Statewide, deaths and other harm to patients from preventable errors such as falls and surgical mistakes have dropped in the 10 years since Minnesota started requiring hospitals and other care centers to report them, according to the report released Thursday.

But the Minnesota Department of Health also said in a related annual report that patient deaths did not decrease in 2013. And patient falls have been particularly difficult to eliminate, the report said.

The department said the 10-year look back shows encouraging progress under the state’s Adverse Health Care Events Law. The law requires hospitals and ambulatory surgery centers to report 29 types of incidents, including bed sores, falls, foreign objects left inside a patient after surgery, surgery on the wrong body part, medication errors and suicides. The law also requires studying how the mistakes happened.

“The AHE law was a catalyst for patient safety throughout the state,” the department’s 10-year evaluation report said. “It has helped bring patient safety to the forefront, increases awareness, and led to focused patient safety activities.”

Deaths from preventable errors declined from a high of 25 in 2006 to a low of five in 2011, according to the report. But the number bounced back up to 14 in 2012, and to 15 in the 2013 reporting year, which ran from October 2012 to October 2013. Ten of those deaths were related to falls.

The annual report said such falls happened despite significant efforts by health care facilities, as well as a safety alert for preventing falls that the health department and Minnesota Hospital Association issued last May.

Total adverse events reported in 2013 were 258, down 18 percent from 2012, driven mostly by a 35 percent decline in pressure ulcers, also known as bed sores. Surgical errors, including wrong-site operations and objects left in patients, fell from a high of 89 in 2011 to 61 in 2013.

Health Commissioner Ed Ehlinger said the hospitals and surgery centers performed 2.6 million procedures in 2012, and in many cases the people who suffered errors were elderly with other risk factors such as dementia or brittle bones, or were on anticoagulants to prevent strokes. He said their deaths are tragic but not surprising.

“They are preventable and our goal is to get them down to a zero level, but the reality is that we probably will never reach that goal,” he said.

The 10-year evaluation from the state Health Department recommended more education and training opportunities, better data sharing and more encouragement for providers to adopt best practices in patient safety.

The Associated Press contributed to this report. Reach Northfield News Managing Editor Jerry Smith at 645-1136. Follow him on Twitter @newsnorthfield.