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?
A statewide strategy which established a clinical risk management programme in small rural hospitals utilising general practitioners in a peer review programme named 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 evaluated successfully in 1999 and rolled out to 5 other Victorian Divisions in 2002-3. Medical records based on 6 criteria are identified by the Health Information Manager at the time of discharge coding and forwarded to GP reviewers who review 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 GP's 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 6 funded agencies, throughout the State of Victoria, which works with 9 local hospitals and associated medical clinics/practices whose GPs have admitting rights. 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 and Maffra District Hospital, together with about 85 active GPs.
Reviewing GP's
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 4 surrounding Divisions, are trained to review medical records in a 2-hour paid training session. 5-6 records are delivered by registered post to the practice approximately ever 2 months, each taking on average 15 minutes to review.
Treating GP's
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 GP reviewers.
Reference Panel
At least 4 GP reviewers constitute a Reference Panel and meetings are generally held quarterly, recommendations are agreed and distributed to all participating GP's and health services for discussion at appropriate 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 & ACRRM. Points are awarded according to the level of involvement in the programme. Visit www.rrmeo.com or www.racgp.com
General Practitioners
Those in the region interested in joining peers in the programme please contact the Co-ordinator.
State-wide Initiatives
§ Record reviewing is now across the regions of the 6 lead Divisions
§ Recommendation issues which have implications State-wide are now reviewed by the Clinical Risk Management Reference Group managed from DHS
§ Programme has recently been badged State-wide
§ The current patient record selection criteria trialed over the last 2 years was not as successful as anticipated and is to change from July 1st 2009
