Incident monitoring

Abstract

At the invitation of the Department of Health, Housing, Local Government and Community Services, the College sought funding for a study on Incident Monitoring in emergency departments. (The identification of potential and actual adverse events which are preventable.) The application was successful, with funding provided to allow for a pilot project incorporating a sample of representative hospitals (teaching, urban and rural). This approach which aims at identifying potential and actual adverse patient incidents had been utilised by the Faculty of Anaesthetists, Royal Australasian College of Surgeons (now Australian and New Zealand College of Anaesthetists) for a number of years with great success. The aim of such an exercise is not only to identify potential and actual incidents but also to identify causation and implement preventive strategies in order to prevent such incidents from occurring. The aims of the project are: The identification and categorisation of adverse patient incidents occurring in public hospital emergency departments in Australia. The development of an effective reporting/data collection system for adverse patient incidents. The facilitation of local quality assurance programs utilising the data collected in the proposal. The development of an ongoing data collection/reporting system leading to the integration of data, both statewide and nationally, in order to identify common problems and trends. The development of proposals to overcome identified problems in order to reduce the incidence of adverse patient incidents. The identification of incidents which are currently reported eg. to coroners courts, complaints units, and those which result in litigation. The quantification of cost savings that can accrue as a result of a reduction in the number of adverse patient incidents. The distribution of the results of the study to all staff working in emergency departments in order to make them more aware of potential problems. Peculiar aspects of emergency departments which highlight the need for such a process include: Patient load is largely “undifferentiated” ie. many and every condition can present with many conditions having signs and symptoms which are similar. Pressure of time on staff to get the work done thus requiring rapid decision making and the “cutting of corners”. The length of contact time with patients is often short, resulting in an inability to monitor patient's progress and, just as importantly, to obtain all the results of all investigations prior to making a more informed decision. The necessity to attend to a number of patients at the same time and to stop what you are doing to attend to something more urgent. Constant activity with little or no time to sit down and think. Staffing largely consisting of junior medical staff, often without adequate supervision. Because of the very nature of the emergency department environment, both potential and actual adverse incidents are thought to be common, thus placing both patient and staff at risk; patients, because of the impact of the incident, and staff because of medico legal ramifications. Without hard data it is very difficult to convince administrators who hold the purse strings to release funds to improve patient care. Documentation of adverse incidents both potential and actual over a period of time, and the involvement of a range of hospitals, will be expected to identify those areas which need attention. Preliminary analysis of results confirms that there are a small but nevertheless very important number of factors contributing to adverse incidents. First on the list is junior unsupervised medical staff on duty after hours. It can therefore be seen that appropriate documentation and analysis of both potential and adverse incidents can assist emergency department managers to seek funds to improve patient care. The concept of incident monitoring leads on to the concept of “risk management” which is in essence the identification of high risk patients/situations and the introduction of preventive strategies in order to reduce the likelihood of an adverse incident. With increasing pressure from both the public and hospitals for an improved standard of care in emergency departments, coupled with the increasingly active legal environment it is becoming more and more important to incorporate risk management into day to day department activities. Particular emphasis should be placed on those areas identified (by such exercises as incident monitoring) as potentially high risk situations. Incident monitoring in one form or another is here to stay, this is also true of risk management and department managers should be encouraged to educate themselves and their staff in relation to the value of incident monitoring and risk management so as to ensure an appropriate standard of care and reduction in legal risk. The final report of the Incident Monitoring Project will be available later this year with a detailed presentation of the study's findings to be presented at a seminar to be held in November.