RISK MANAGEMENT AND PATIENT SAFETY NEW FACULTY ORIENTATION AUGUST 13, 2015

WUSM OFFICE OF RISK MANAGEMENT 2 PURPOSE PROTECT THE ASSETS OF THE INSTITUTION LOSS PREVENTION –MEDRISK TRAINING PROGRAM LOSS CONTROL LOSS FINANCING

WUSM OFFICE OF RISK MANAGEMENT 3 RISK MANAGEMENT STAFF DIRECTOR MANAGERS –RISK –CLAIMS SUPPORT STAFF –INSURANCE VERIFICATION –CREDENTIALING –EDUCATION

WUSM OFFICE OF RISK MANAGEMENT 4 PROFESSIONAL LIABILITY INSURANCE PROGRAM COVERAGE –DUTIES OF POSITION –OTHERS WITH WU DEAN APPROVAL RESIDENTS - BJH/SLCH LIMITS $10M SIR VERIFICATION OF INSURANCE

WUSM OFFICE OF RISK MANAGEMENT 5 FACT AND EXPERT WITNESS TESTIMONY FACT TESTIMONY –CARE PROVIDED BY WUSM FACULTY EXPERT WITNESS TESTIMONY –OPINION TESTIMONY –WUSM CODE OF CONDUCT –EXPERT WITNESS AFFIRMATION FORM

WUSM OFFICE OF RISK MANAGEMENT 6 STATUTE OF LIMITATIONS MALPRACTICE--2 YRS WRONGFUL DEATH--3 YRS MINORS--20 YRS; DEATH THEN 3 YRS EXCEPTIONS –PSYCHIATRY –CONTINUING TX –PRODUCTS

WUSM OFFICE OF RISK MANAGEMENT 7 EARLY REPORTING ACCURATE RECALL LEGAL REPORTING REQUIREMENTS EARLY PATIENT DISCUSSION ACCURATE HX DATA - EXCESS INS EVALUATE EXPOSURE ADJUST BILLS DECREASE FINANCIAL LOSS BY ID TRENDS ADEQUATE FUNDING LEVELS

WUSM OFFICE OF RISK MANAGEMENT 8 REQUIRED REPORTS DEATH PARAPLEGIA, QUADRIPLEGIA, PARALYSIS SPINAL CORD NERVE INJURY, NEUROLOGICAL DEFICIT BRAIN DAMAGE TOTAL/PARTIAL LOSS OF LIMB OR USE OF LIMB SENSORY OR REPRODUCTIVE ORGAN LOSS OR IMPAIRMENT SERIOUS DISFIGUREMENT

WUSM OFFICE OF RISK MANAGEMENT 9 OTHER RISK MANAGEMENT INQUIRIES AND ACTIVITIES RECORD REQUEST LIEN LETTERS SUBPOENA SUMMONS EARLY RESOLUTION BOARD OF HEALING ARTS DEBRIEFINGS PROCESS MAPPING ATTORNEY CALLS

WUSM OFFICE OF RISK MANAGEMENT 10 SUMMONS

WUSM OFFICE OF RISK MANAGEMENT 11 PETITION

WUSM OFFICE OF RISK MANAGEMENT 12 SUBPOENA

WUSM OFFICE OF RISK MANAGEMENT 13 BOARD OF HEALING ARTS

WUSM OFFICE OF RISK MANAGEMENT 14 HOW TO REPORT WU CALL RM or –SAFE LINE—747-SAFE (7233) ELECTRONIC REPORTING SYSTEM (ERS) –ERS is WRITE/DICTATE “IN ANTICIPATION OF LITIGATION” DISCUSS W/RM, DEPT HEAD, LEGAL COUNSEL ATTORNEY CLIENT PRIVILEGE

WUSM OFFICE OF RISK MANAGEMENT 15 COMMUNICATE AND DOCUMENT BE AVAILABLE GOOD LISTENER COMMUNICATE WITH FAMILY MEMBERS EDUCATE RETURN TELEPHONE CALLS BILLS (MEDICARE REQUIREMENTS)

WUSM OFFICE OF RISK MANAGEMENT 16 INFORMED CONSENT DUTY OF PHYSICIAN PATIENT’S DECISION - DON’T PRESSURE REALISTIC EXPECTATIONS, OWN LANGUAGE DO NOT RELY ON STANDARD FORMS

WUSM OFFICE OF RISK MANAGEMENT 17 ELEMENTS DEFINE PROBLEM RISKS, BENEFITS, ALTERNATIVES ALTERNATIVES -- RISKS AND BENEFITS LIKELY TO HAPPEN IF UNTREATED PRESENTED LEVEL OF UNDERSTANDING CONFIRMATION - ASK PATIENT WHAT THEY UNDERSTAND WILL HAPPEN

WUSM OFFICE OF RISK MANAGEMENT 18 MEDRISK TRAINING PROGRAM PROMOTE PATIENT SAFETY AND DECREASE MEDICAL ERRORS SUBSPECIALTY-SPECIFIC TRAINING MODULES CME 4-5 HOURS ON LINE efault.aspxhttp://washu.medrisk.com/Medrisk/Welcome/d efault.aspx

WUSM OFFICE OF RISK MANAGEMENT 19 RISK MANAGEMENT WEB SITE GENERAL INFORMATION EVENT REPORTING SYSTEM (ERS) PROFESSIONAL LIABILITY INSURANCE EDUCATION SECTION

WUSM OFFICE OF RISK MANAGEMENT 20 Patient Safety Education WUSM Event Reporting System Support for Disclosure Conversations Support for Clinicians after Adverse Events Event Analysis support: debriefings, root cause analysis, second victim support PS/QI Projects based upon high volume or high risk processes with identified failures PATIENT SAFETY— Patient Safety Office Resources

WUSM OFFICE OF RISK MANAGEMENT 21 Patient Safety Education Curriculum and searchable library available on PS Website – Speaker’s bureau of WUSM PS Experts available Conferences and webinars available on- site

WUSM OFFICE OF RISK MANAGEMENT 22 Physicians Use Quick Submit (<3 minutes to complete) PATIENT SAFETY WUSM Event Reporting System

WUSM OFFICE OF RISK MANAGEMENT 23 Traditional Voluntary Reporting in Hospitals Lost Opportunities to Learn  Key Findings: Hospital staff did not report 86% of events to incident reporting systems Physician accounted for less than 2% of reports Hospital Incident Reporting Systems Do Not Capture Most Patient Harm. January 2012 OEI  Low physician reporting is problematic because it hinders the ability to identify and mitigate risks. Physicians view health care through a unique lens, which allows them to identify certain types of hazards and certain contributing factors better than others. Noble, DJ, Pronovost, Underreporting of Patient Safety Incidents Reduces Health Care’s Ability to Quantify and Accurately Measure Harm Reduction. J Patient Saf 2010; 6:24

WUSM OFFICE OF RISK MANAGEMENT 24 A Different Approach to Physician Reporting —Stimulated Reporting  M & M cases  Patient Safety Triggers : National or Local  PS Indicators (AHRQ)  IHI Global Trigger Tool  PS Triggers (see pocket card)

WUSM OFFICE OF RISK MANAGEMENT 25 Click Quick Submit to enter a new event

WUSM OFFICE OF RISK MANAGEMENT 26 A Quick Submission takes <30 seconds!

WUSM OFFICE OF RISK MANAGEMENT 27 Following an adverse event or error Take care of the patient Respond professionally by being transparent and reporting it in a confidential online report at ers.wusm.wustl.edu and to Risk Management at If this happens to you, don’t isolate, but consider your own needs and ask for help from a trained peer support physician or staff clinician by calling the WUSM Patient Safety Support line at Event analysis may take place (interview, debriefing, root cause analysis, M&M or case review). We recommend you not go to analysis meetings alone. Seek out peer support or departmental assistance. We can walk you through this, explain the process and be with you during these meetings. Support for Clinicians After Adverse Events/Errors

WUSM OFFICE OF RISK MANAGEMENT 28 Practical Patient Safety — What Can You Do?  Develop a strong personal professional routine  Recognize your role on the team:  Solicit wide and independent input/Solicit discordant views  Develop a shared mental model and identify when the plan needs to shift  Be approachable –know the members of your team by name  Be preoccupied with failure—observe systems, identify weaknesses and report them to Patient Safety  Communicate using best practices: Closed loop communication (“read-back”), Assure Attending-to-Attending communication on critical cases  When things go wrong: take care of the patient, report it, support those involved and seek help at , ask about prevention of future events

WUSM OFFICE OF RISK MANAGEMENT 29 WUSM Patient Safety Office Mary Taylor, JD Robin Woltman (ERSystem) Patient Safety website

QUESTIONS?