Clinical

The Clinical Indemnity Scheme-

National Clinical Incident Reporting system.

OECD Health Care Quality Indicators Seminar on improving Patient Safety Data Systems. June 29th. 2006

Dr.Ailis Quinlan, Head Clinical Indemnity Scheme

Clinical Indemnity Scheme

• Objectives

– To drive and support a patient safety culture

– To reduce the number of clinical claims

– To manage clinical claims in a cost-effective and timely manner

CIS-Who does it cover ?CIS-Who does it cover ?

87 Enterprises to date

• Health Service Executive / Statutory Body• Public Voluntary Hospitals• Other Agency commissioned to provide clinical

services to eligible patients• 66,000 staff

CIS-What does it coverCIS-What does it cover ?

Professional Medical Services

(a) Services provided by Registered Medical Practitioners or Registered Dentists of a diagnostic or palliative nature, or consisting of the provision of treatment in respect of any illness, disease, injury or any other medical condition.

(b) Services provided by other health professionals in the performance of their duties.

(c) Services connected with the provision of health or medical care provided by persons acting under the direction of the persons to whom (a) or (b) applies.

Population Republic Of Ireland, 2002

0 500,000 1,000,000 1,500,000

0-1415-1920-2425-4445-5455-5960-64

65+

Age

gro

up

Male Female

Total Pop. 3.9m. - Census 2002. CSO, Ireland

(Est. 4.2m-2006)

Clinical Risk Management – Statistics RoI

• HIPE* Data 2004– Day cases = 423,031– In-Patients = 560,419– Total = 983,450

• Harvard – 4% adverse events• Australian Study – 16% adverse events• Expect 37-150,000 clinical incidents per annum

from acute sector

* Hospital In-patient Enquiry System

Statutory Duty of Enterprises

•Reporting of adverse incidents to the SCA

•Furnish relevant information

•Preserve relevant evidence

•Permit and facilitate SCA investigation

STARSweb-National Clinical Incident Reporting System

Web-based clinical incident reporting system -Electronic, highly secured, confidential

-Adverse events and “near misses”

-National Rollout of system

STARSweb-Data related Issues Confidentiality/Security•Virtual Private Network (VPN)

•Encrypted data

•Digital certificate downloaded on personal PC and renewed every 12 months

•Password protected-forced to change every month

•Discontinuance of session-if no input in 15 minutes

•Each enterprise can access only its own data

STARSweb-Data related Issues IT Connectivity

•Internet

•Large enterprises-High speed leased lines

•Smaller enterprises-Broadband

STARSweb-Data related Issues Data quality assurance

•Development of Q/A tool.

•Training in Data entry

•Train the Trainers curriculum developed .

STARSweb-Data related Issues Stakeholder consultation

•Ongoing opportunity for feedback from end-users

•STARSweb Users Forum

STARSweb-Data related Issues Compliance with Legislation

•Freedom of Information

•Data Protection

Likelihood of reporting Incident

•Midwives more likely than doctors.

•Junior staff more likely than senior.

Vincent, Stanhope, J Eval Clin Practice 1999; 5 (1):13-21

STARSweb-Data related Issues“Buy-in by Healthcare professionals

STARSweb-Data related Issues“Buy-in” by Healthcare professionals

Reasons for not reporting:

•Fear of blame

•High workload.

•Belief that incident did not warrant report.

Solutions

•Simplified methods of reporting

•Clear definitions

•Education.

•Feedback

•Reassurance to staff re purpose.Vincent, Stanhope, J Eval Clin Practice 1999; 5 (1):13-21

Recommended OECD Dataset on STARSweb

General incident type captured

•Hospital Acquired infections

•Operative and Post-operative complications

•Complications of Anaesthesia

•Obstetrics

•Patient falls

Recommended OECD Dataset on STARSweb

Sentinel Events Captured

•Wrong site surgery.

•Retained instruments/material post-op. requiring further surgery.

•Medical equipment related adverse event.

•Haemolytic blood tranfusion reaction due to ABO incompatibility.

•Medication errors inc. those leading to death of patient.

Recommended OECD Dataset and STARSweb

General incident type, e.g., Complications of Anaesthesia

Specific nature of event,

•Anaesthetic awareness

•Problematic intubation inc aspiration/dental damage

•Mendelsohn’s Syndrome

•Post-operative pain

•Equipment failure/malfunction

N.B. Not possible to capture “Post-operative nausea”

45%

11%9%

35% Breakdown:

Slips, Trips & Falls

Treatment incidents

Medication incidents

Other

Progress to dateOver 64,000 clinical incidents / “near misses”

logged on the live system to date

Active claims by type adverse event. N=1,700

Peri-op. / peri-procedure

24%

Diagnosis18%

Not Specified13%

Peri-natal11%

Treatment11%

Slips/Trips/Fall5%

Consent/confidentiality

6%

Others9%

Medication3%

Integrated Clinical Risk Management/Claims Management

Enterprises Incident

Clinical Risk Manager

Clinical

Indemnity

SchemeClinical Claims

Clinical Risk Manager Adviser

STARS

CIS will disseminate best practice information/lessons learnt throughout the Enterprises

• Annual conference/workshops

• Website

• Newsletter

• Training

STARSweb-Use of Data

Thank you.