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The Clinical Indemnity Scheme- National Clinical Incident Reporting system. Dr.Ailis Quinlan, Head Clinical Indemnity Scheme. OECD Health Care Quality Indicators Seminar on improving Patient Safety Data Systems. June 29 th . 2006. Clinical Indemnity Scheme. Objectives
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The Clinical Indemnity Scheme- National Clinical Incident Reporting system. Dr.Ailis Quinlan, Head Clinical Indemnity Scheme OECD Health Care Quality Indicators Seminar on improving Patient Safety Data Systems. June 29th. 2006
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 ?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 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.
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
STARSweb-Data related Issues “Buy-in by Healthcare professionals 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 • 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”
Progress to date Over 64,000 clinical incidents / “near misses” logged on the live system to date
STARSweb-Use of Data • CIS will disseminate best practice information/lessons learnt throughout the Enterprises • Annual conference/workshops • Website • Newsletter • Training