RISK MANAGEMENT AND PATIENT SAFETY

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

2. PURPOSE • PROTECT THE ASSETS OF THE INSTITUTION • LOSS PREVENTION • MEDRISK TRAINING PROGRAM • LOSS CONTROL • LOSS FINANCING

3. RISK MANAGEMENT STAFF • DIRECTOR • MANAGERS • RISK • CLAIMS • SUPPORT STAFF • INSURANCE VERIFICATION • CREDENTIALING • EDUCATION

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

5. 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

6. STATUTE OF LIMITATIONS • MALPRACTICE--2 YRS • WRONGFUL DEATH--3 YRS • MINORS--20 YRS; DEATH THEN 3 YRS • EXCEPTIONS • PSYCHIATRY • CONTINUING TX • PRODUCTS

7. ACCURATE RECALL LEGAL REPORTING REQUIREMENTS EARLY PATIENT DISCUSSION ACCURATE HX DATA - EXCESS INS EVALUATE EXPOSURE ADJUST BILLS DECREASE FINANCIAL LOSS BY ID TRENDS ADEQUATE FUNDING LEVELS EARLY REPORTING

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

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

10. SUMMONS

11. PETITION

12. SUBPOENA

13. BOARD OF HEALING ARTS

14. 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

15. BE AVAILABLE GOOD LISTENER COMMUNICATE WITH FAMILY MEMBERS EDUCATE RETURN TELEPHONE CALLS BILLS (MEDICARE REQUIREMENTS) COMMUNICATE AND DOCUMENT

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

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

18. 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/default.aspx

19. RISK MANAGEMENTWEB SITEhttp://medicine.wustl.edu/risk • GENERAL INFORMATION • RISK MONITOR PRO – EVENT REPORTING SYSTEM (ERS) • PROFESSIONAL LIABILITY INSURANCE • EDUCATION SECTION

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

21. 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

22. Patient Safety Education • Curriculum available on PS Website • Speaker’s bureau of WUSM PS Experts available • Conferences and webinars available on-site

23. PATIENT SAFETYWUSM Event Reporting System • http://ers.wusm.wustl.edu

24. Traditional Voluntary Reporting in Hospitals Lost Opportunities to Learn • Key Findings: • Hospital staff did not report 86% of events to incident reporting systems • 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 Health Care’s Ability to Quantify and Accurately Measure Harm Reduction. J Patient Saf 2010; 6:24

25. 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)

26. Click Quick Submit to enter a new event

27. A Quick Submission takes <30 seconds!

28. 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

29. QUESTIONS?