More comprehensive reporting mechanisms have led to an increased number of reported complications in hospitals across Connecticut, according to a recently released Adverse Events Report.

The report, compiled each year and comprising data from the year prior, documented 534 adverse events at all inpatient and outpatient facilities in 2013, as compared to 244 in 2012. Yale-New Haven Hospital’s rate of adverse events, which range from a fall to the effects of malpractice, rose to 22.9 per 100,000 patient days, the total number of days all admitted patients spend in the hospital. The year before, that number was eight per 100,000.

“We’ve been very aggressive with amping up efforts to track adverse events,” said Joshua Copel, Yale School of Medicine professor of obstetrics, gynecology, reproductive sciences and pediatrics.

Copel said that measures to improve reporting involve coaching physicians on what questions might come up and how to answer them when informing a patient about an adverse event. These measures may make physicians more comfortable, and thus more likely to report adverse events.

Copel added that actors have come in to train the physicians, and coaches are available to accompany physicians while they disclose a complication.

According to the report, the incidence rate of three of the four most common adverse events as a whole has remained roughly stable, with falls, perforations and objects left in the body after surgical procedures listed as the most common causes of complications. But because of an expanded definition of “pressure ulcer,” more commonly known as bedsores, overall rates of adverse events have risen significantly. Although they are becoming rarer, falls were still the most prevalent adverse event.

At Yale-New Haven, bedsores caused 70 of the 94 adverse events that the hospital reported in 2013.

Those numbers may seem large, but Yale Medical Group Chief Medical Officer Ronald Vender MED ’77 said that clinicians are encouraged to report every adverse event, even those that do not reach patients’ attention.

He added that even though staff and physicians are trained in creating “a culture of safety,” accidents still occur. Thus, every major complication undergoes a formal, comprehensive and standardized investigation, he said.

“A key principle of achieving high reliability is to increase reporting,” said Michelle Sharp, director of communications and public affairs at the Connecticut Hospital Association. “We expected to see the number of reported events rise.”

While the hospital encourages all parties involved in health care to report complications, patients are not always aware of when adverse events happen, and thus are not always able to report incidents, Copel explained.

He added that many errors do not harm patients in any way, and so they are not always reported. While Copel noted that some people think physicians should report every error, others think that reporting is only necessary when harm has occurred.

Vender said that while Connecticut as a state has higher than average adverse report incidents, Yale-New Haven’s rates of complications are below the state average.

“If you look at the larger hospitals in the state, we have better performance, despite doing more complex and difficult cases than other hospitals,” he said, referring to the high number of endoscopies performed at Yale-New Haven. That procedure, which involves passing a tube down a patient’s digestive tract, can lead to perforations.

Sharp noted that the addition of extra categories in the database of complications may have led to a higher number of cases across the state. The report expanded the documentation of bedsores to accommodate those that are “unstageable” — sores so obscured by dead tissue that the depth of the wound is indeterminable. This added 226 more incidences that were not recorded before.

Vender said the hospital itself keeps track of all adverse events in real time, and that this report, conducted by the Connecticut Department of Public Health, may not be the most reflective of current adverse event reporting levels because it is over a year old. Since the report only discusses issues that occurred in 2013, it does not consider changes that have been made since then, including changes that came out of a two-day conference on quality and safety in September 2014.

Events at Yale-New Haven accounted for 19 percent of the total number of adverse events that occurred at acute care hospitals in the state in 2013.