The Purpose and Goals of Risk Management in the Sleep Center Melinda Trimble, RPSGT, RST, LRCP
Objectives Overview of Risk Management as a concept What is the purpose of Risk Management and what are its goals? Define how the goals of Risk Management impact the health care facility Tips for structuring an effective Risk Management program
Risk Management..the process of making and carrying out decisions that will assist in the prevention of adverse events and minimize the effects of those events.
Risk Management in the Health Care Organization Risk Management was introduced into the health care industry in response to the malpractice crisis Hospitals were facing higher settlements and more plaintiff verdicts Higher insurance rates Decreased availability of some specialties
Risk Management Two terms prevalent in risk management literature as defined by the International Risk Management Institute Inc. (1991) are: Risk: Uncertainty arising from the possible occurrence of a given event Exposure: A state of being subject to loss because of some hazard or contingency
Risk Management in the Health Care Setting Historically, health care organizations managed risk in a reactive manner Each department worked independently to resolve its own issues
Risk Management in the Health Care Setting This lack of centralized reporting led to disparate, duplicative efforts and unnecessary spending Relevant trends and patterns were overlooked because it never occurred to one department to share certain information with another The study of overall data was difficult or impossible
For Example: The lab implements a process to reduce labeling errors in response to repeated patient incidents; however, nursing was not part of the development process, as a result; The process required multiple revisions Patient safety was compromised by repeated revisions, and Additional costs were incurred because of duplicative efforts
Risk Management Turbulent economic times led health care organizations to take a broader perspective toward managing risk. Tort Reform was the lawmaker s response to the turbulent economic times There has been a SHIFT from reactive risk management to strategic risk management Strategic risk management utilizes a centralized incident management and/or reporting system
State Laws Risk Management plays a important role in maintaining compliance with relevant state laws Most states have very specific hospital licensing regulations that must be complied with - in addition to regulatory requirements In some instances, state requirements are more restrictive than Joint Commission or federal requirements in those instances, the facility should follow state laws
HIPAA Congress had an expectation that HIPAA would force the healthcare industry to adopt standards
HIPAA Original purpose was creating electronic means for payment and collecting claims data Focus became privacy and security Did not pre-empt state law! HIPAA Privacy is the federal floor, but acknowledges that some states laws provide even more rigorous protections (e.g. those covering HIV disclosure, mental health records, etc.)
HIPAA Established broad new patients rights relating to: Access and release of medical records as well as restrictions on the use of medical records and/or protected health information (PHI) Ability for patients to request amendments to and accounting of the disclosures that have been made of their medical records Giving the patient a private right of action when breaches in security have led to identifiable PHI disclosures
Compliance Programs QI - Quality Improvement QA - Quality Assurance
What is QI Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it
Quality Improvement Sequence Trigger(s) - your wake-up call Organizational Changes - such as development of committees Problem Identification and Solving - a standardized systematic, multidisciplinary team approach to identifying a problem and developing action plans - holding team leaders accountable for results Practice Changes - new protocols and practices including evidence based policies and procedures, clinical pathways and guidelines Better Outcomes - in process and health-related measures, patient satisfaction and work environment
What is Quality Assurance Quality Assurance is a range of activities including: Review Evaluation Surveillance Appraisal, and Monitoring They collectively comprise the intelligence gathering arm of quality Improvement
QA Activities Quality - doing those things necessary to meet and exceed the needs and expectations of those we serve and doing the right things right every time Review - the process of critical reflection used by clinicians wishing to assess their own (or their peer s) performance Audit - review that is conducted on a continuous and routine basis Evaluation an assessment of the impact of a service on indices of health
QA Activities Surveillance - a routinely repeated evaluation Appraisal - ad hoc data collection and analysis by management in relation to health care delivery Monitoring - ongoing appraisal
Quality Management Customer Service Patient Safety It is a holistic approach to the art of managing quality output considering together the people, process and products rather than independent factors and driven towards the objective with effective and efficient performance output. Personnel Documents & Records Equipment
Components of Quality System Promoting Quality Correcting Quality Determination of Quality Requirement Management Systems for Quality Promotion of Standards and Guidelines Regulations Payments System Management Information Q U A L I T Y Policy and Management Decision Making Health Outcomes Practices Satisfaction Complaints Beneficiaries Empowerment and Participation Quality Monitoring
What is the Role of the Health Care Risk Manager? Healthcare risk managers identify and evaluate risk as a means to reduce injury to patients, staff members and visitors within an organization. Risk managers work proactively and reactively to either prevent incidents or to minimize the damages following an event.
Each Center Faces Unique Challenges Patient Safety Mandatory Federal Regulations Potential Medical Errors Policy and Procedure Development Legislation Impacting Healthcare You Must Stay UP To Date!
Example: Patient Safety Fall Risk in the Sleep Center
What is the cost of a fractured hip? A fractured hip can cost a healthcare center approximately $100,000 to $225,000
Consequences of a Fall Death Loss of Function Injury Increased Hospital Cost Legal Cost
Fall Safety / Staff Training / Policies Fall Safety Program Assessment Before and During Admission to the Sleep Center Train Staff on: Falls Risk Assessment Falls Risk Intervention Age Risk Medications
JC Injuries from Falls Issues Identified by Analysis 90% - Incomplete Staff Orientation and Training 55% - Inadequate Caregiver Communication 40% - Incomplete Assessment or Reassessment
Example: Medical Charting Do you have a policy? Do you review charting with your staff? Have you ever provided Medical Charting education for your sleep staff? Legal Experts say they are noticing more liability cases that involve faulty medical charting.
Medical Charting Proper charting of medical records is imperative in assuring safety and a proper standard of care for our patients. Poor charting increases risk of being involved in a medical malpractice action. In a court of Law If you did not document it It did not happen You control the facts and evidence that is going to be used to prosecute or defend you in a medical malpractice action.
Medical Charting Your charting should tell the full story of what happened from the time the patient came into the sleep center until they walked out Poor charting can make you look sloppy, and at worst untruthful
Medical Charting Only FACT should be charted Chart all conversations with medical staff about the patient s condition Incomplete documentation is one of the most common errors If the records are incomplete, inaccurate, Illegible, or altered the plaintiff attorney has very strong merit to pursue the case
Medical Records Apply guidelines Locate appropriate documentation resources Understand your responsibility to provide and document patient information Identify the medical record as protected and confidential information Identify legal aspects of proper documentation Understand that the medical record documents the care of the patient and is an important element contributing to high quality care Medical records may serve as a legal document to verify the care provided
Remember With documentation of medical records particular emphasis must be placed on the five factors that improve the quality and usefulness of chart information: Accuracy Relevance Completeness Timeliness Confidentiality
Lets Talk Risk What are some other Risk Management issues in the Sleep Center setting?
Are you Ready? Do you have? Quality Systems Quality Manuals Quality Procedures Quality Plan Doing Self Audits Tracking Systems (to stay on top of Federal and State regulations and law changes) Documentation of Staff Training
In Review Why do you think Risk management programs are important in the sleep center?
Thank you! Questions?