RISK MANAGEMENT AND PATIENT SAFETY NEW FACULTY OREINTATION

RISK MANAGEMENT AND PATIENT SAFETY NEW FACULTY OREINTATION AUGUST 14, 2013

PURPOSE • PROTECT THE ASSETS OF THE INSTITUTION • LOSS PREVENTION – MEDRISK TRAINING PROGRAM • LOSS CONTROL • LOSS FINANCING WUSM OFFICE OF RISK MANAGEMENT 2

RISK MANAGEMENT STAFF • DIRECTOR • MANAGERS – RISK – CLAIMS • SUPPORT STAFF – INSURANCE VERIFICATION – CREDENTIALING – EDUCATION WUSM OFFICE OF RISK MANAGEMENT 3

PROFESSIONAL LIABILITY INSURANCE PROGRAM • COVERAGE – DUTIES OF POSITION – OTHERS WITH WU DEAN APPROVAL • RESIDENTS - BJH/SLCH • LIMITS 2014 - $6 M SIR/$20 M/$10 M • VERIFICATION OF INSURANCE WUSM OFFICE OF RISK MANAGEMENT 4

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 WUSM OFFICE OF RISK MANAGEMENT 5

STATUTE OF LIMITATIONS • • MALPRACTICE--2 YRS WRONGFUL DEATH--3 YRS MINORS--20 YRS; DEATH THEN 3 YRS EXCEPTIONS – PSYCHIATRY – CONTINUING TX – PRODUCTS WUSM OFFICE OF RISK MANAGEMENT 6

EARLY REPORTING • ACCURATE RECALL • LEGAL REPORTING REQUIREMENTS • EARLY PATIENT DISCUSSION • ACCURATE HX DATA - EXCESS INS WUSM OFFICE OF RISK MANAGEMENT • EVALUATE EXPOSURE • ADJUST BILLS • DECREASE FINANCIAL LOSS BY ID TRENDS • ADEQUATE FUNDING LEVELS 7

REQUIRED REPORTS • DEATH • PARAPLEGIA, QUADRIPLEGIA, PARALYSIS • SPINAL CORD • NERVE INJURY, NEUROLOGICAL DEFICIT • BRAIN DAMAGE WUSM OFFICE OF RISK MANAGEMENT • TOTAL/PARTIAL LOSS OF LIMB OR USE OF LIMB • SENSORY OR REPRODUCTIVE ORGAN LOSS OR IMPAIRMENT • SERIOUS DISFIGUREMENT 8

OTHER RISK MANAGEMENT INQUIRIES AND ACTIVITIES • RECORD REQUEST • LIEN LETTERS • SUBPOENA • SUMMONS • EARLY RESOLUTION WUSM OFFICE OF RISK MANAGEMENT • BOARD OF HEALING ARTS • DEBRIEFINGS • ROOT CAUSE ANALYSIS • ATTORNEY CALLS 9

SUMMONS WUSM OFFICE OF RISK MANAGEMENT 10

PETITION WUSM OFFICE OF RISK MANAGEMENT 11

SUBPOENA WUSM OFFICE OF RISK MANAGEMENT 12

BOARD OF HEALING ARTS WUSM OFFICE OF RISK MANAGEMENT 13

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 WUSM OFFICE OF RISK MANAGEMENT 14

COMMUNICATE AND DOCUMENT • BE AVAILABLE • GOOD LISTENER • COMMUNICATE WITH FAMILY MEMBERS • EDUCATE WUSM OFFICE OF RISK MANAGEMENT • RETURN TELEPHONE CALLS • BILLS (MEDICARE REQUIREMENTS) 15

INFORMED CONSENT • DUTY OF PHYSICIAN • PATIENT’S DECISION - DON’T PRESSURE • REALISTIC EXPECTATIONS, OWN LANGUAGE • DO NOT RELY ON STANDARD FORMS WUSM OFFICE OF RISK MANAGEMENT 16

ELEMENTS • • • DEFINE PROBLEM RISKS, BENEFITS, ALTERNATIVES -- RISKS AND BENEFITS LIKELY TO HAPPEN IF UNTREATED PRESENTED LEVEL OF UNDERSTANDING CONFIRMATION - ASK PATIENT WHAT THEY UNDERSTAND WILL HAPPEN WUSM OFFICE OF RISK MANAGEMENT 17

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 WUSM OFFICE OF RISK MANAGEMENT 18

RISK MANAGEMENT WEB SITE http: //medicine. wustl. edu/risk • GENERAL INFORMATION • RISK MONITOR PRO – EVENT REPORTING SYSTEM (ERS) • PROFESSIONAL LIABILITY INSURANCE • EDUCATION SECTION WUSM OFFICE OF RISK MANAGEMENT 19

PATIENT SAFETY— WUSM PS Physician Council • • • Anesthesiology Emergency Dept. Internal Medicine Neurosurgery OB/GYN Ophthalmology Orthopedics Otolaryngology Pediatrics Radiation Oncology Radiology Surgery WUSM OFFICE OF RISK MANAGEMENT Andrea Vannucci Chris Carpenter, Richard Griffey, Rob Poirier Emily Fondahn, Mike Lane, Myra Rubio Paul Santiago vacant David Vollman Kathryn Keeler Brian Nussenbaum Nikoleta Kolovos, Pele Yu, George Van Hare Imran Zoberi James Duncan, Andrew Bierhals Doug Schuerer 20

PATIENT SAFETY— Patient Safety Office Resources • 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 WUSM OFFICE OF RISK MANAGEMENT 21

Patient Safety Education • Curriculum available on PS Website • Speaker’s bureau of WUSM PS Experts available • Conferences and webinars available onsite WUSM OFFICE OF RISK MANAGEMENT 22

PATIENT SAFETY WUSM Event Reporting System • http: //ers. wusm. wustl. edu WUSM OFFICE OF RISK MANAGEMENT 23

Traditional Voluntary Reporting in Hospitals Lost Opportunities to Learn § Key Findings: ü Hospital staff did not report 86% of events to incident reporting systems ü 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 24 WUSM OFFICE OF RISK MANAGEMENT Reduction. Health Care’s Ability to Quantify and Accurately Measure Harm 24

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 25

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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 WUSM OFFICE OF RISK MANAGEMENT 28

QUESTIONS?