The Clinical Indemnity Scheme National Clinical Incident Reporting

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 – 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. 9 m. - Census 2002. CSO, Ireland (Est. 4. 2 m-2006)

Clinical Risk Management – Statistics Ro. I • 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

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

Integrated Clinical Risk Management/ Claims Management Enterprises Clinical Indemnity Scheme Incident Clinical Risk Manager STARS Clinical Risk Adviser Clinical Claims Manager

STARSweb-Use of Data CIS will disseminate best practice information/lessons learnt throughout the Enterprises • Annual conference/workshops • Website • Newsletter • Training

Thank you.