Translating Knowledge from Medical Legal Claims to Improve Quality and Safety
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1 Translating Knowledge from Medical Legal Claims to Improve Quality and Safety NHLC, 15 June 2015 Polly Stevens, VP RM Margaret Dumoulin, Pt Advocacy Spec. PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
2 Objectives Understand challenges associated with learning from medical-legal claims Learn how a large, non-profit insurance provider collated knowledge from claims and translated it across the healthcare system to improve safety. Learn how a large teaching hospital has incorporated the program in their improvement plans. 2 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
3 HIROC Disclosure We are owned and governed by you HC organizations Employees, volunteers, boards Midwives MDs in leadership Regulatory colleges National associations We are not-for-profit We are passionate about patient safety 3 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
4 A maddening aspect of the malpractice system: it is so politically charged that its potential as a rich source of patient safety knowledge and wisdom generally go untapped. Wachter, 2012, p.336 4
5 Claims are a potentially important source of information on the causes of harm to patients Inherent limitations Low frequency Selection bias Hindsight bias Timescale 5 Vincent, 2006
6 Claims & Anesthesia Harvard Medical Practice Study 6 Cheney, 1988 Brennan, Leape, et al 1991
7 HIROC s Approach Learning from Failures Risk Ranking Risk Reference Sheets Risk Assessment Checklists 7 Scale and Spread
8 Top Risks by Costs 1. OB Failure to identify/respond to abnormal fetal status 2. Dx Misinterpreted laboratory results 3. Medical (ED) Inadequate triage assessment and documentation 4. OB Mismanagement of oxytocin administration 5. Dx Failure to communicate critical test results 6. OB Failure to monitor fetal status 7. Falls Visitor 8. OB Failure to communicate fetal status 9. Property Water damage 10. Medical Failure to appreciate status changes/patient deterioration 8 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
9 The Obstetrics Four (e.g.) 9 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
10 Self Assessment Building on RRS Due diligence exercise Yes/No/Partial implementation of each mitigation strategy Help ID improvement priorities Online Risk Assessment Checklists program Overall score by risk Financial incentive 10 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
11 11 Year Over Year Results (Matched Cases Acute Care)
12 Highest & Lowest Scores (Yr 2) Highest Surgical Wrong patient/site/procedure 98 Surgical Retained foreign bodies 97 Surgical Inadequate sterility 96 Lowest Medical Failure to provide adequate discharge/followup instructions Medical Failure to identify/manage IV infiltration 82 Medical Failure to identify/monitor hyperbilirubinemia Organizations without obstetrical services PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
13 Obstetrics Risks 13 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
14 The Ottawa Hospital is one of the largest Academic Health Centers in Canada 1,127 Beds 3 campuses Average length of stay = 8.1 Days Our Team: 11,813 - Staff 1,398 - Physicians 1,100 - Volunteers
15 The Ottawa Hospital: Our Patients 49,341 - Patient Admissions 34,537 - Surgical Cases 13,659 - Eye Care Surgical Cases 166,137 - Emergency Visits 1,058,658 - Ambulatory Care Visits 6,516 - Babies delivered 16,006,336 - Laboratory Procedures
16 Context Patient Advocacy 5 full-time Patient Advocacy Specialists aligned to clinical programs Concerns Management Clinical Risk Management Claims Management Education 1 full-time Triage Coordinator 1 part-time Special Projects Specialist
17 Risk Assessment Checklist s Process September 2012: HIROC assigned our 32 Risk Modules. Risk Assessment Checklists assigned to Clinical Directors according to: content in risk reference sheets relation to portfolio claim descriptions
18 Risk Assessment Checklist s Process April 13: Completed checklists information was entered into a database by Coordinator May/June: Received report ranking the 31 risks (1 was N/A for TOH) TOH chose 3 areas to focus on over the next 3 years (Interesting parallels when comparing HIROC results with our TOH Quality Plan)
19 Risk Assessment Checklist s Process Years 2 & 3 Late Fall: Directors were sent the Risk Assessment Checklists applicable to their areas where the responses had been partial or no in previous year April: Updates for each of the mitigation strategies were submitted.
20 TOH HIROC TOH s Top 10 Risks Extent to which TOH has mitigation strategies in place % % % Risk Rank Rank Year 1 Year 2 Year Wrongful Dismissal - Administration Failure to Provide Adequate Discharge/Follow-up Instructions Healthcare Acquired Pressure Sores Inadequate ED Triage Assessment Water Damage Wrong Patient/Site/Procedure Failure to identify/manage IV infiltration Failure to Appreciate Status Changes/Deteriorating Patient Condition Unnecessary/Obsolete Procedures Employee Fraud
21 What worked well Simplicity of the checklists and description of mitigation strategies Simplicity of answers requested yes/partial/no Mitigation strategies were suggested not demanded Involvement from the Directors and their programs has been 100% since day one One project Coordinator to facilitate checklists and compilation of responses
22 Lessons Learned Parallels between RAC results and our Quality Plan Mitigation strategies supported the ongoing efforts of teams TOH OBS team had most of the recommended mitigation strategies already in place. Data was provided about each portfolio s implementation strategies and success.
23 Next Steps Share results of Year 3 with Senior Management Team/Portfolios. Identify areas where mitigation strategies are to be implemented and most responsible team(s). Begin the next 3 year cycle Just launched ERM/IRM
24 Polly Stevens Margaret Dumoulin 24 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
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