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ENQual Complaint registration and risk management for specific groups in Spain

ENQual Complaint registration and risk management for specific groups in Spain. Susana Lorenzo MD, MPH, PhD Quality Manager Fundación Hospital Alcorcón. 2002 National health service desegregated Autonomous Communities. Cultural changes in health care risk.

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ENQual Complaint registration and risk management for specific groups in Spain

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  1. ENQual Complaint registration and risk management for specific groups in Spain Susana Lorenzo MD, MPH, PhD Quality Manager Fundación Hospital Alcorcón

  2. 2002 National health service desegregated Autonomous Communities

  3. Cultural changes in health care risk • New diagnosis and therapeutic methods: 5% incidence of toxic reactions and important accidents (1955). • Illnesses consequence of medicine progress (1956). • 20% of hospitalized patients undergo health complications. 4,7% were important (1964). Barr DP. Hazards of modern diagnosis and therapy - the price we pay. JAMA 1955; 159: 1452.Moser RH. Diseases of medical progress. N Engl J Med 1956; 255: 606.Schimmel EM. The hazards of hospitalization. Annals of Internal Medicine 1964; 60(1): 100-110.

  4. ADVERSE EFFECTS HOSPITAL HEALTHCARE New York1State, 1984. • 3,7% hospitalized patients AE. 13,6% deaths (98.000 deaths/year). • Half preventable. Many avoidable. Colorado & Utah2, 1992. • 2,9% hospitalized patients AE. 6,6% deaths (44.000 deaths/year). • Half preventable. Many avoidable. 1Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I-II. NEJM 1991; 324: 370-84.2 Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000; 38: 261-71

  5. Risk management: patients Alicante: research multicentric project Madrid: research project: anesthesia Salamanca: monitoring project Barcelona: monitoring project

  6. http://www.dsp.umh.es/proyectos/idea/index.html

  7. OBJETIVES • To identify and define hospital healthcare AE. • To determine the incidence of AE in 13 services of 8 hospitals. • To analyze the patients’ and healthcare characteristics’ associated to AE. • To estimate the impact of AE distinguishing avoidable and non-avoidable AE.

  8. DESIGN • Cohort Prospective Multicentric Study. • Qualitative study. • Nested study: • diagnostic test evaluation : Screening Guide. • Effectiveness of the studies to detect AE in Obstetrics. • AE Impact on newborn Obstetrics • AE in colorectal cancer. • surgeons opinion on AE in practice • .../...

  9. Aragón: • - Hospital C. Universitario Lozano Blesa (Zaragoza) • - Servicio de Cirugía General • - Servicio de Psiquiatría • - Hospital Miguel Servet de Zaragoza: • - Servicio de Cirugía General • - Servicio de Psiquiatría Ámbito del estudio: Comunidad Valenciana: - Hospital General Universitario de Alicante: - Servicio de Ginecología y Obstetricia - Servicio de Cirugía General - Hospital C. Universitario de San Juan de Alicante: - Servicio de Cirugía General - Hospital de San Vicente del Raspeig de Alicante. • Comunidad Canaria: • - Complejo Hospitalario Materno Insular de Gran Canaria • - Servicio de Ginecología y Obstetricia • Madrid: • - Hospital Universitario 12 de Octubre • - Servicio de Cirugía General • - Servicio de Psiquiatría • - Servicio de Medicina Interna • Andalucía: • - Hospital Universitario Virgen de las Nieves (Granada) • - Servicio de Cirugía General

  10. OPERATIVE DEFINITION Every accident or incident in the Medical Record that might have caused harm to the patient, linked to health care conditions or to the patient ones’.

  11. STUDY ESTRATEGY SAMPLE 1.000 medical record AE Screening Guide 20% Medical record screening 200 Modular Questionnaire MRF2 20% ADVERSE EVENTS 40 Analysis Moment:every 2 days and discharge.

  12. SCREENING GUIDE • Previous hospitalization <12 meses antes (si >65 años: 6 meses) • Neoplasic Treatment Previous to hospitalization • Trauma during hospitalization • Drug adverse reaction during hospitalization • Temperature >38.3ºC the day before discharge • transfer from general unit to special care unit • Transfer to another acute hospital • Second surgery during hospitalization • Treatment or intervention due to damage during an invasive procedure • New neurological Deficit at discharge • AMI, CVA o PTE during or after an invasive procedure • Cardio/respiratory Stop • Damage or complication related to abortion, amniocentesis or labor. • Death • Opened Surgery not foreseen or hospitalization for surgical intervention • Damage or complication related to ambulatory surgery or invasive procedure that caused hospitalization or emergency evaluation • AdverseEffect. • Notes in the medical record that might suggest litigation • Nosocomial Infection.

  13. Piloting of MRF2 • Aim - to test and comment on quality of form - not to conduct an AE study • 12 teams took part in the piloting of the MRF2 (Britain, Italy, France, Spain, Australia, New Zealand, Japan & USA) • Completed new forms and evaluation questionnaires • Instructions - to take time to understand review process and interpret definitions correctly Maria Woloshynowych, PhD Clinical Safety Research Unit Imperial College London. Measuring Errors and Adverse Events in the UK. Valencia - 16 May 2003.

  14. AnesthesiaCommunication and analysis of critical incidents Antonio Bartolomé Ruibal Área de Anestesia, Reanimación y Cuidados Críticos Fundación Hospital Alcorcón

  15. Anesthesia patient security Model or myth? Muertes relacionadas con la anestesia (Por 10.000 anestesias) Modified from Lagasse RS. Anesthesia safety: Model or myth? Anesthesiology 2002; 97: 1609-17.

  16. Anesthesia patient security Model not myth • Non traditional research techniques • critical Incident • ASA Closed Claims Study • Australian Incident Monitoring Study • Technology • Standards and guidelines • Human factor and system focus Gaba DM. Anesthesiology as a model for patient safety in health care. BMJ 2000; 320: 785-8.

  17. Critical Incident “(...) This study was one of a few pivotal events responsible for the dramatic success in promoting anesthesia patient safety (...)” Pierce EC. Looking back on the anesthesia critical incident studies and their role in catalysing patient safety. Qual Saf Health Care 2002;11:282-3.

  18. Communication and analysis of critical incident system • Fundación Hospital Alcorcón 1999. • CQI • Anonymous communication and voluntary of critical incidents. • Root analysis. • Improvement actions. • Does not need negative publicity

  19. Results * n (%) No clinical effect 260 (58.3 %) Low Morbidity 104 (23.3 %) Intermediate Morbidity 63 (14.1 %) High Morbidity 11 (2.5 %) Death 6 (1.3 %) Results1999-2003 • 44311 anesthetic procedures • 446 critical incidents (1 %) * Definitions According to Lunn JN. Anaesthesia 1985; 40: 79.

  20. Improvement actions • New protocols (6) • Modification of previous protocols (2) • IC Modification (1) • Hazardous material discharge (4) • New material (4) • equipment repair (2) • equipment modification (3) • Sessions (16) • Alerts (13)

  21. Claim management. Madrid Regional Service. Order 605/2003 21 april Suggestions and Claim Hospital Public Service • < 30 days • any client can use it • where, reception procedure • answering procedure • follow up and evaluation commision • annual follow up

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