Firenze,Firenze,23 Ottobre 200423 Ottobre 2004

Clinical Risk Management in Italy

State of the Art

Clinical Risk Management in Italy

State of the Art

Riccardo Tartaglia, MD, Ph. DClinical Risk Management and

Patient Safety CentreRegione Toscana

WHENWHEN

WHYWHY

WHOWHO

WHATWHAT

did the problem arise?

is it important to act?

is involved?

HOWHOW

are our plans ?

can we enhance patient safety?

WHENWHEN

The problem of medical errors has always existed but in these last 5 years it bursted

- Rapid increase of insurance costs- The patient-doctor relationship has

changed and expectations of cure both in quantity and quality have increased in recent years

- Scientific literature reports a high number of deaths due to medical errors (Institute of Medicine, 2000)

did the problem arise?

WHYWHY

Primum non nocere The number of lawsuits has increased. In Italy

there are about 12,000 per year (2002), but only 5000 healthcare professionals are condemned (CINEAS - Consortium for insurance engineering)

In Italy insurance costs have sensibly increased and, for example, in Tuscany these costs for hospitals are estimated about € 31.500.000

CINEAS estimates between 15.000 and 50.000 the number of deaths due to medical errors in Italy

Patient injuried parties claim for an amount of 2.5 billions € in compensations

is it important to act?

WHOWHO

The departments or wards with the highest number of lawsuits are:

Orthopaedics 16.5% Oncology 13.0 Surgery 10.6 Gynaecology 10,8

(Cittadinanza attiva, Italy 2002)

is involved?

WHATWHAT Promote a reporting and learning culture Create a database of adverse events/alert

reports (volontary incidents reporting) for an organization with memory

An organization based on memory through a Clinical audit as an educational instrument for clinical risk management

Information campaigns on specific issues for patient safety implementation (wrong site intervention, hospital infections, patient identification, and medication therapy)

Develop usable ICT for healthcare systems (electronic records, alert systems, wireless devices for therapies subministration, hospital information systems)

are our plans ?

HOWHOW Involving healthcare top management

Promoting a reporting and learning culture through informational sensibilazation

Promoting clinical audits on sentinel and adverse events, unsure actions among all the areas involved

Ensuring the presence of Clinical Risk Managers in every hospital (doctors, nurses or other professionals with a specific training in human factor)

Training specific personnel in risk management

By means of the guidelines for patient safety enhancement promoted by the Italian Healthcare Ministry (cognitive approach)

can we enhance patient safety?

A view on the Italian experiencesA view on the Italian experiences “Palmhospital” computerized Phisicians Order

Entry by palmar vs HWP in 17 infective diseases wards of Lombardia Region

Regione Emilia Romagna, Regional Agency for Health: pilot study of voluntary reporting systems

Regione Toscana, Azienda Sanitaria di Firenze (4 hospitals in Florence): clinical audits as a method to improve patient safety (a voluntary reporting system) and two campaigns: cleaning hands for preventing hospital infections, and to avoid the trascription of therapy from clinical records to other forms (unified therapeutical form)

Certified clinical record ISO 9000 (Niguarda Hospital Milano)

Regione Lazio, Azienda Sanitaria di Roma: a voluntary reporting systems

Regione Veneto: hospital discharge record as an instrument to track errors

Knowing is not enough, we must applyWilling is not enough, we must do.

Goethe

Thank you for your attention