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
747-2933
Robin Woltman (ERSystem)
747-6388
Sharepoint site
http://patientsafety.wusm.wustl.edu
QUESTIONS?