INCIDENTS AND COMPLAINTS

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INCIDENTS AND COMPLAINTS
HOPE/SCC-QUALITY/2001-1 annex 3

• INSALUD
• Spain

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NATIONAL INSTITUTE OF HEALTH OF SPAIN
(INSALUD) Public network 15 Million people 80
Hospitals 1053 Primary health care centers
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CONTRACTS

• Activity
• Budget
• Common Quality Plan
• Standards
• Quality Objectives for Improvement
• Indicator Monitoritation

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Areas

• Patients rights,
• Information systems
• Risk management
• Waiting lists
• Implementing protocols, clinical guidelines, and
  pathways of care in commonly occurring
  procedures.

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STANDARDS

• Standard 5 Claims and Complaints management.
  The hospital manage correctly the patients
  complaints.
• Criteria
• There is a department at hospital responsible for
  managing the patient claims.
• The department has a system that guarantees the
  answer in less than 30 days.
• The answer is adapted to some criteria (No
  general answers)
• Hospital make a cause analysis report which is
  spread to the professionals involved
• Improvement actions are implemented

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• QUALITY OBJECTIVES FOR IMPROVEMENT
• Objective 1. Patients rights
• 1.3. Informed Consent Program
• Ethics Committee
• Information plan in clinical services
• Patient report

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• QUALITY OBJECTIVES FOR IMPROVEMENT
• Objective 5. To reduce adverse effects produced
  by health care
• 5.1. Fall incidents
• Preventative actions relating to fall risks
• Incident report procedures
• 5.2.Adverse events produced by medicaments
• Preventative actions relating to error
• Monodoses (100 beds)
• Improvement teamwork
• Incident report procedures
• 5.3 Adverse drogues effects
• Incident report procedures

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Indicators monitoritation

• Avoidable mortality Tase
• Colecistectomy
• Appendectomy
• Hernia
• Maternal and neonatal
• Postoperative mortality (48h)
• Pressure ulcer prevalence
• Surgical site infection
• Ambulatory surgical patient admitted for
  complication
• Unscheduled returns to the operating room
• Unscheduled readmission for the same or related
  condition
• Unscheduled readmission in ED for the same or
  related condition
• Waiting time in ED
• Surgical procedure cancellation
• Patient questionnaires based in problems defined
  by patients

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Clinical Committees

• Mortality Committee
• Avoidable mortality
• Other causes of mortality
• Infection Committee
• Pharmacy Committee
• Error prevention program

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Insidents and complaints

• National policies
• Laws and requlations, liability, - patients
  rights - accidents and insidents - health
  care quality system requirements
• Claims, malpractice - obstetrics
• Topics - hospital infections
• Insurances state/consultants -national patient
  insurances
• Courts and commissions to judgethe insidents
• Quality management policies - learn from
  mistakes - national reporting and corrective
  actions - local reporting and corrective
  actions

• Quality management protocols and criteria
  - systems approach - indicators
• Risk Masnagements
• National insurances
• National reporting, statistical analyses -
  quality registers - general complaints,
  adverse events, insidents
• National data available
• National committees etc to review
• Local / hospital policies
• Patient reports/questionnaires
• Other reports Media, Quality Audits.