The Clinical Indemnity Scheme

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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
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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

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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

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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.

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Total Pop. 3.9m. - Census 2002. CSO,
Ireland (Est. 4.2m-2006)
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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

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• Statutory Duty of Enterprises
• Reporting of adverse incidents to the SCA
• Furnish relevant information
• Preserve relevant evidence
• Permit and facilitate SCA investigation

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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

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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

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STARSweb-Data related Issues IT
Connectivity

• Internet
• Large enterprises-High speed leased lines
• Smaller enterprises-Broadband

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STARSweb-Data related Issues Data quality
assurance

• Development of Q/A tool.
• Training in Data entry
• Train the Trainers curriculum developed .

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STARSweb-Data related Issues Stakeholder
consultation

• Ongoing opportunity for feedback from end-users
• STARSweb Users Forum

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STARSweb-Data related Issues Compliance with
Legislation

• Freedom of Information
• Data Protection

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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
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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
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Recommended OECD Dataset on STARSweb

• General incident type captured
• Hospital Acquired infections
• Operative and Post-operative complications
• Complications of Anaesthesia
• Obstetrics
• Patient falls

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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.

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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
• Mendelsohns Syndrome
• Post-operative pain
• Equipment failure/malfunction
• N.B. Not possible to capture Post-operative
  nausea

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Progress to date
Over 64,000 clinical incidents / near misses
logged on the live system to date
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Active claims by type adverse event. N1,700
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Integrated Clinical Risk Management/Claims
Management
STARS
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STARSweb-Use of Data

• CIS will disseminate best practice
  information/lessons learnt throughout the
  Enterprises
• Annual conference/workshops
• Website
• Newsletter
• Training

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Thank you.