Clinical Risk Management

What is the Division's Clinical Risk Management program?
Small rural hospitals with only one or two doctors often find it difficult to sustain formal medical quality improvement programs. It can be difficult to objectively review the medical records of patients treated by professional colleagues, or for a doctor working on their own to objectively review their own work.

This led to the implementation of Limited Adverse Occurrence Screening (LAOS) in Victorian rural regions, via Divisions of General Practice.

The aim of the initiative is to improve patient safety by:

• Gaining senior executive and clinician support, and
• Changing the culture of error management from individual blame to that of identifying the systemic issues involved.

Program components

• Data collection, recording and management tools.
• Interested and motivated general practitioners recruited to become reviewers.
• A program officer employed to coordinate the program and provide administrative support.
• Effective systems to manage the highly confidential information securely.

Benefits to rural General Practitioners

• Knowledge and experience being shared in a non threatening way and recommendations leading to quality improvement in small rural hospitals
• Identification of trends difficult for GPs and small rural hospitals to recognise on their own
• Input into state policy matters
• Local quality improvement forums with recommendations and material for further discussion on patient care, educational and system issues
• Eligibility for clinical audit points towards maintaining vocational registration through the Royal Australian College of General Practitioners or Australian College of Rural and Remote Medicine
• Improved documentation to assist in the continuity of patient care.

Benefits to hospitals

• An independent review of some of their medical records.
• Identification of both medical and system issues that occur in the region.
• Access to recommendations resulting from a review of adverse events that have occurred at their hospital and others of similar size.
• General practitioner involvement with hospital quality improvement programs.
• Improved standard of documentation in the medical record.

Process overview

1. The Health Information Manager at participating hospitals screens the medical record of discharged patients during the routine coding process.
2. Medical records identified by the screening criteria are photocopied and sent to the Division program officer.
3. The program officer forwards the photocopied medical records to a general practitioner trained reviewer from a separate geographical area for objective review to identify preventable adverse patient events. GPs with similar specialities are used for review.
4. The reviewing GP returns the medical record to the program officer, who may forward it to the original treating GP for comment.
5. The reference panel comprises reviewing GPs. It meets quarterly to discuss adverse events and identify any clinical and/or system issues that require recommendations. A report of recommendations is then sent to all general practitioners within the Division and the chief executive officers of the participating hospitals.
6. Reference panel recommendations are discussed for modification and improvement at the various hospital quality improvement forums, and feedback provided to the reference panel on courses of action or interventions undertaken.

Process flowchart

Coding data entry, registered mail record tracking are used to maintain the confidentiality of the copied medical records.