Department of Health

Maintaining Information on Adverse Patient Incidents at Hospitals and Clinics

If a patient in a hospital or a clinic dies or suffers an impairment of bodily functions in circumstances other than those related to the natural course of illness, disease or proper treatment, the hospital or clinic is required to report the event (which is labeled an “occurrence”) to the Department of Health. Information about the reported occurrences is maintained on the Department’s NYPORTS database. This database can be accessed by medical facilities, and the facilities are expected to use the information in internal efforts to improve patient care and reduce medical error. The Department also relies on the database in certain statewide improvement efforts. During our audit period of nearly 29 months, a total of 65,822 occurrences were recorded on NYPORTS.

We examined the completeness and security of the NYPORTS database and found that improvements are needed. For example, hospitals do not always report occurrences, and the information reported by clinics is not always entered on the database. We also identified long delays in the reporting of required information. Because of these various weaknesses, the NYPORTS database may not be as useful as it could be in helping to improve patient care and reduce medical error. We also found that, while the automated data processing controls established to protect the validity and confidentiality of NYPORTS information are generally adequate, certain improvements are needed in these controls.

For a complete copy of Report 2003-S-27 click here.
For a copy of the 90-day response click here.