Clinical Risk Management in Italy State of the Art

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Clinical Risk Management in ItalyState of the
Art
Riccardo Tartaglia, MD, Ph. D Clinical Risk
Management and Patient Safety Centre Regione
Toscana
Firenze, 23 Ottobre 2004
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WHEN
did the problem arise?
WHY
is it important to act?
WHO
is involved?
WHAT
are our plans ?
HOW
can we enhance patient safety?
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WHEN
did the problem arise?

• 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)

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WHY
is it important to act?

• 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

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WHO
is involved?

• 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)

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WHAT
are our plans ?

• 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)

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HOW
can we enhance patient safety?

• 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)

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A 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

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• Knowing is not enough, we must apply
• Willing is not enough, we must do.
• Goethe

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Thank you for your attention