Clinical Risk ManagementDot Humphrey-Lesque

 
 
Program Manager: Dot Humphrey–Lesque
 
 
Funded By: State Department of Health
 
Programme Commenced: May 2002
 
What is Clinical Risk Management? 
 
The detection, monitoring, prevention and early management of clinical incidents aimed at improving patient care through active minimisation of risk.
 
What is the programme? 
 
The programme is part of a State-wide strategy which established a method of managing clinical risk in small rural hospitals utilising general practitioners to peer review selected patient records. Titled Limited Adverse Occurrence Screening (LAOS). The programme was developed at the Wimmera Base Hospital, Horsham in 1994 and, in collaboration with West Vic Division of General Practice, was further developed, trialed and evaluated successfully in 1999 then in 2002-3 rolled out to five other lead Victorian Divisions and all small rural hospitals in the State. The Health Information Manager (HIM) from participating hospitals, at the time of discharge, identifies medical records based on six criteria. These are copied then forwarded to the Program Co-ordinator who dispatches a number to GP reviewers trained in the methodology of review and who assesses for the presence of adverse events or education opportunities. De-identified data are analysed by a panel of GP reviewers and opportunities for system and/or patient care improvement, in the form of recommendations, are shared with all hospitals and GPs across the programme.
 
Why the Division?
 
Small Rural Hospitals can find difficulty sustaining formal medical involvement in hospital and medical improvement processes because of the small number of doctors in some hospitals and minimal administrative support. The model was evaluated as suitable as a genuine peer review programme which can involve medical staff in these facilities.
GPA South Gippsland is one of the six funded agencies, throughout the State of Victoria, which works with local Gippsland hospitals and associated medical clinics/practices whose GPs have admitting rights. Together with about 108 active GPs the following South and East Gippsland health services participate in the local programme - Kooweerup Regional Health Service, Bass Coast Regional Health - Wonthaggi Hospital, Gippsland Southern Health Service incorporating Leongatha and Korumburra Hospitals, South Gippsland Hospital - Foster, Yarram Health Service, Omeo District Health, Orbost Regional Health Service, Maffra District Hospital and, in 2010, Bairnsdale Regional Health Services joined the programme..
 
Reviewing GPs
 
Visiting Medical Officers (VMO) with admitting rights to the participating health services are encouraged to become part of the programme as GP reviewers. GP members of four surrounding Divisions are trained to review medical records in a 2-hour remunerated training session. Five to six records are delivered by registered post to the selected GP reviewer practice approximately two monthly, each record taking, on average, 15 minutes to review.
 
Treating GPs
 
If an adverse event or educational opportunity is detected by the reviewing GP, the record is forwarded to the treating GP for 'right of reply' and the opportunity to provide any additional information relevant to the case prior to further review by a Reference Panel made up of invited GP reviewers.
 
Reference Panel
 
At least four GP reviewers constitute a quorum for Reference Panel meetings which are held when adequate records are available for discussion. Recommendations are agreed, researched for contemporary practice and distributed to all participating GPs and health services for discussion at appropriate local quality forums and relevant action.  Statutory Immunity protects information at this forum.
 
CPD Clinical Audit Points
 
The programme attracts CPD/PDP Clinical Audit Points for both professional colleges RACGP and ACRRM. Points are awarded according to the level of involvement in the programme. Visit http://www.rrmeo.com/ or http://www.racgp.com/
 
General Practitioners
 
Those in the region interested in joining peers in the programme please contact the Coordinator. 
 
State-wide Initiatives
  •       Record reviewing is now across the regions of the six lead Divisions
  •       Recommendation issues which have implications State-wide are now reviewed by a State DH committee for further consideration of solutions to
        the issues.
  •       Programme is badged State-wide
 
 
Useful Web Sites
Australian Commission on Safety & Quality in Healthcare http://www.safetyandquality.gov.au/
State Government of Victoria, Department of Health http://www.health.vic.gov.au/clinrisk/publications/laosreview.htm
http://www.health.vic.gov.au/clinrisk/whatis.htm
Australasian Association of Quality in Health Care http://www.aaqhc.org.au/