risk management and patient safety new faculty orientation august 13, 2015
TRANSCRIPT
RISK MANAGEMENT AND PATIENT SAFETY
NEW FACULTY ORIENTATION AUGUST 13, 2015
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PURPOSE
• PROTECT THE ASSETS OF THE INSTITUTION
• LOSS PREVENTION– MEDRISK TRAINING PROGRAM
• LOSS CONTROL• LOSS FINANCING
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RISK MANAGEMENT STAFF
• DIRECTOR
• MANAGERS– RISK– CLAIMS
• SUPPORT STAFF– INSURANCE VERIFICATION– CREDENTIALING– EDUCATION
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PROFESSIONAL LIABILITY INSURANCE PROGRAM
• COVERAGE– DUTIES OF POSITION– OTHERS WITH WU DEAN
APPROVAL• RESIDENTS - BJH/SLCH• LIMITS 2016 - $10M SIR• VERIFICATION OF INSURANCE
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FACT AND EXPERT WITNESS TESTIMONY
• FACT TESTIMONY– CARE PROVIDED BY WUSM FACULTY
• EXPERT WITNESS TESTIMONY– OPINION TESTIMONY– WUSM CODE OF CONDUCT– EXPERT WITNESS AFFIRMATION
FORM
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STATUTE OF LIMITATIONS
• MALPRACTICE--2 YRS• WRONGFUL DEATH--3 YRS• MINORS--20 YRS; DEATH THEN 3 YRS• EXCEPTIONS
– PSYCHIATRY– CONTINUING TX– PRODUCTS
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EARLY REPORTING
• ACCURATE RECALL
• LEGAL REPORTING REQUIREMENTS
• EARLY PATIENT DISCUSSION
• ACCURATE HX DATA - EXCESS INS
• EVALUATE EXPOSURE
• ADJUST BILLS• DECREASE
FINANCIAL LOSS BY ID TRENDS
• ADEQUATE FUNDING LEVELS
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REQUIRED REPORTS
• DEATH
• PARAPLEGIA, QUADRIPLEGIA, PARALYSIS
• SPINAL CORD
• NERVE INJURY, NEUROLOGICAL DEFICIT
• BRAIN DAMAGE
• TOTAL/PARTIAL LOSS OF LIMB OR USE OF LIMB
• SENSORY OR REPRODUCTIVE ORGAN LOSS OR IMPAIRMENT
• SERIOUS DISFIGUREMENT
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OTHER RISK MANAGEMENT INQUIRIES AND ACTIVITIES
• RECORD REQUEST
• LIEN LETTERS• SUBPOENA• SUMMONS• EARLY
RESOLUTION
• BOARD OF HEALING ARTS
• DEBRIEFINGS• PROCESS
MAPPING• ATTORNEY CALLS
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SUMMONSSUMMONS
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PETITIONPETITION
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SUBPOENA
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BOARD OF HEALING ARTS
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HOW TO REPORT
• WU CALL RM--362-4686 or 362-6956– SAFE LINE—747-SAFE (7233)
• ELECTRONIC REPORTING SYSTEM (ERS)– ERS is http://ers.wusm.wustl.edu
• WRITE/DICTATE “IN ANTICIPATION OF LITIGATION”
• DISCUSS W/RM, DEPT HEAD, LEGAL COUNSEL
• ATTORNEY CLIENT PRIVILEGE
• WU CALL RM--362-4686 or 362-6956– SAFE LINE—747-SAFE (7233)
• ELECTRONIC REPORTING SYSTEM (ERS)– ERS is http://ers.wusm.wustl.edu
• WRITE/DICTATE “IN ANTICIPATION OF LITIGATION”
• DISCUSS W/RM, DEPT HEAD, LEGAL COUNSEL
• ATTORNEY CLIENT PRIVILEGE
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COMMUNICATE AND DOCUMENT
• BE AVAILABLE• GOOD LISTENER• COMMUNICATE
WITH FAMILY MEMBERS
• EDUCATE
• RETURN TELEPHONE CALLS
• BILLS (MEDICARE REQUIREMENTS)
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INFORMED CONSENT
• DUTY OF PHYSICIAN• PATIENT’S DECISION - DON’T PRESSURE• REALISTIC EXPECTATIONS, OWN
LANGUAGE• DO NOT RELY ON STANDARD FORMS
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ELEMENTS
• DEFINE PROBLEM• RISKS, BENEFITS, ALTERNATIVES• ALTERNATIVES -- RISKS AND BENEFITS• LIKELY TO HAPPEN IF UNTREATED• PRESENTED LEVEL OF UNDERSTANDING• CONFIRMATION - ASK PATIENT WHAT
THEY UNDERSTAND WILL HAPPEN
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MEDRISK TRAINING PROGRAM
• PROMOTE PATIENT SAFETY AND DECREASE MEDICAL ERRORS
• SUBSPECIALTY-SPECIFIC TRAINING MODULES
• CME 4-5 HOURS• ON LINE• http://washu.medrisk.com/Medrisk/Welcome/d
efault.aspx
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RISK MANAGEMENTWEB SITE
http://medicine.wustl.edu/risk
• GENERAL INFORMATION• EVENT REPORTING SYSTEM (ERS)• PROFESSIONAL LIABILITY
INSURANCE• EDUCATION SECTION
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• Patient Safety Education
• WUSM Event Reporting System
• Support for Disclosure Conversations
• Support for Clinicians after Adverse Events
• Event Analysis support: debriefings, root cause analysis, second victim support
• PS/QI Projects based upon high volume or high risk processes with identified failures
PATIENT SAFETY—Patient Safety Office Resources
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Patient Safety Education
• Curriculum and searchable library available on PS Website – http://patientsafety.wusm.wustl.edu
• Speaker’s bureau of WUSM PS Experts available
• Conferences and webinars available on-site
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• http://ers.wusm.wustl.edu
• Physicians Use Quick Submit (<3 minutes to complete)
PATIENT SAFETYWUSM Event Reporting System
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Traditional Voluntary Reporting in Hospitals Lost Opportunities to Learn
Key Findings: Hospital staff did not report 86% of events to incident reporting
systems Physician accounted for less than 2% of reports
Hospital Incident Reporting Systems Do Not Capture Most Patient Harm.
January 2012 OEI-06-09-00091
Low physician reporting is problematic because it hinders the ability to identify and mitigate risks. Physicians view health care through a unique lens, which allows them to identify certain types of hazards and certain contributing factors better than others.
Noble, DJ, Pronovost, Underreporting of Patient Safety Incidents Reduces
Health Care’s Ability to Quantify and Accurately Measure Harm Reduction .
J Patient Saf 2010; 6:24
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A Different Approach to Physician Reporting—Stimulated Reporting
M & M cases Patient Safety Triggers: National or Local PS Indicators (AHRQ) IHI Global Trigger Tool PS Triggers (see pocket card)
WUSM OFFICE OF RISK MANAGEMENT 25Click Quick Submit to enter a new event
WUSM OFFICE OF RISK MANAGEMENT 26A Quick Submission takes <30 seconds!
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Following an adverse event or error• Take care of the patient
• Respond professionally by being transparent and reporting it in a confidential online report at ers.wusm.wustl.edu and to Risk Management at 362-6956
• If this happens to you, don’t isolate, but consider your own needs and ask for help from a trained peer support physician or staff clinician by calling the WUSM Patient Safety Support line at 747-1477
• Event analysis may take place (interview, debriefing, root cause analysis, M&M or case review). We recommend you not go to analysis meetings alone. Seek out peer support or departmental assistance. We can walk you through this, explain the process and be with you during these meetings.
Support for Clinicians After Adverse Events/Errors
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Practical Patient Safety —What Can You Do?
Develop a strong personal professional routine Recognize your role on the team:
Solicit wide and independent input/Solicit discordant views Develop a shared mental model and identify when the plan needs to shift Be approachable –know the members of your team by name
Be preoccupied with failure—observe systems, identify weaknesses and report them to Patient Safety
Communicate using best practices: Closed loop communication (“read-back”), Assure Attending-to-Attending communication on critical cases
When things go wrong: take care of the patient, report it, support those involved and seek help at 747-1477, ask about prevention of future events
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WUSM Patient Safety Office
• Mary Taylor, JD
747-2933
Robin Woltman (ERSystem)
747-6388
Patient Safety website
http://patientsafety.wusm.wustl.edu
QUESTIONS?