RISK MANAGEMENT AND PATIENT SAFETY

NEW FACULTY OREINTATION AUGUST 14, 2013

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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 2014 - $6M SIR/$20M/$10M/$10M • 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• ROOT CAUSE

ANALYSIS• 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)

• RISK MANAGEMENT PRO—– 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)

• RISK MANAGEMENT PRO—– 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• RISK MONITOR PRO – EVENT

REPORTING SYSTEM (ERS)• PROFESSIONAL LIABILITY

INSURANCE• EDUCATION SECTION

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PATIENT SAFETY—WUSM PS Physician Council

• Anesthesiology Andrea Vannucci• Emergency Dept. Chris Carpenter, Richard Griffey, Rob Poirier• Internal Medicine Emily Fondahn, Mike Lane, Myra Rubio • Neurosurgery Paul Santiago• OB/GYN vacant• Ophthalmology David Vollman• Orthopedics Kathryn Keeler • Otolaryngology Brian Nussenbaum• Pediatrics Nikoleta Kolovos, Pele Yu, George Van Hare• Radiation Oncology Imran Zoberi• Radiology James Duncan, Andrew Bierhals• Surgery Doug Schuerer

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• Patient Safety Education

• WUSM Event Reporting System

• Support for Communication of Adverse Events to patients and families

• 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 available on PS Website

• Speaker’s bureau of WUSM PS Experts available

• Conferences and webinars available on-site

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• http://ers.wusm.wustl.edu

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 26Click Quick Submit to enter a new event

WUSM OFFICE OF RISK MANAGEMENT 27A Quick Submission takes <30 seconds!

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WUSM Patient Safety Office

• Mary Taylor, JD

taylorma@wusm.wustl.edu

747-2933

Robin Woltman (ERSystem)

woltmanr@wusm.wustl.edu

747-6388

Sharepoint site

http://patientsafety.wusm.wustl.edu

QUESTIONS?