Development Of Risk Management Strategies Research Articles

Telephone advice for neurosurgical referrals. Who assumes duty of care?

The rising rate of litigation against all specialities provides an incentive to develop risk management strategies. Much of a neurosurgeon's workload is telephone advice, which is rarely documented formally. This leaves us vulnerable to other clinicians' interpretation of our advice, their record of our conversation and poor accuracy of recall by both parties. We performed a prospective study of all telephone conversations with referring clinicians over 1 year, in order to assess the quality of information transfer. We found that the information received was often inaccurate, documentation of our given advice was poor, and criticism of neurosurgical care was unfounded. We have developed a proforma to be faxed back to the referring team. This will ensure that the information received, and the advice given in return, is recorded formally by both teams. Only time will tell if a joint record such as this will provide sufficient defence against litigation.

Perioperative Transfusion Medicine

One always enjoys reading books that seem immediately familiar. All anaesthetists reading this book will repeatedly come to passages that they know something about. Equally they may meet parts that suddenly explain in an objective and informative way how wrong they have been in their peri-operative transfusion practices. Transfusion medicine has developed rapidly into a complex and specialist area. The relatively simplistic approach that most clinicians had to transfusion has been challenged and forced to change in recent times. This has been due to a complex interaction of new blood-borne viral illnesses, an ageing population undergoing more complex surgery and a blood transfusion service struggling to meet demand for allogeneic blood. This long and weighty book is an example of how this area of medicine has changed. To produce a 600-page book which acts as a reference for only peri-operative transfusion should stimulate most anaesthetists to open its cover, purely to satisfy their curiosity. The book is divided into six sections; after a very brief historical first section of one chapter, the second section deals with the physiological and haematological principles which one should consider in the surgical patient, prior to transfusing allogeneic blood. This section, which contains 12 chapters, also addresses the infectious risks of transfusion and the principle of autologous predonation. Alternative oxygen carriers are given two chapters with one on polymerised human haemoglobin, another on perfluorocarbon emulsions. The third collection of chapters discusses issues which have to be addressed in the pre-operative preparation of our patients. There is a chapter devoted to practical aspects of resuscitation in the haemorrhaging patient. This chapter offers some guidance on how we should approach our resuscitation with reference to the basic principles of oxygen delivery and its dependence on adequate blood volume. Although much of this chapter is familiar territory to anaesthetists, it is nevertheless useful to have the main principles summarised in a single chapter. In fact this is a theme of the whole book and inevitably there is a great deal of repetition on some topics. This is an advantage of the book, as the reader can turn to a single chapter to get an overview, without the need to hop between different chapters. Section four covers transfusion management and blood conservation measures during the operative period, whilst the fifth section highlights practice in specific surgical areas. The last section has two chapters which again examine the management of anaemic patients and the reasons when transfusion may be given or safely withheld. In summary, the 37 chapters of this book cover many of the different areas of peri-operative transfusion practice. Of course some chapters are much longer than others, but I was impressed with the summative style used. This, combined with the extensive references, allows a brisk read but with the facility to delve deeper into a topic by using the relevant reference. The diagrams and figures are clear and simple, conveying their message in a direct way, and the index is straightforward and accurate. In the preface to this book, it is mentioned that the public is calling for a zero-risk blood supply — an impossible aim, as to eliminate all known risk is the best one can achieve. One way of minimising risk is by developing risk management strategies, which in the case of blood transfusion means doing your best to minimise or even avoid altogether your patient's exposure to allogeneic blood. This book goes a long way to helping the interested anaesthetist to develop a rational approach to peri-operative blood transfusion.

The assessment and management of risk in psychiatry: can we do better?

This is the final contribution to a five part series on risk in psychiatry. Bowden (1997) has cast a bleak eye on the realities of making risk decisions about difficult and dangerous patients, identifying the essential subjectivity of these decisions and the cognitive distortions that psychiatrists can undergo to make them apparently easier; distortions that can blind the clinician to impending disaster. Morgan (1997) emphasised the limitations of a simplistic ‘risk factor’ approach to the management of potentially suicidal patients, concluding that the priority is the refinement of our basic clinical skills (and by implication deployment of successful treatments for our patients' illnesses). Prins (1997) analysed the particular difficulties faced by mental health review tribunals hearing the cases of Restricted patients. The perhaps unsurprising conclusion is that tribunals make bad decisions when presented with inadequate information (which begs the question why not adjourn and seek the information required before proceeding?). Roy (1997) has addressed a range of risks faced by Trusts and the clinicians who work for them. There is a clear demand that Trusts develop risk management strategies: of necessity these strategies will discourage inherently risky behaviour such as inadequate staffing of in-patient units and the devolution of inappropriate levels of responsibility to staff who are inadequately trained or supported.

Mentors to Combat School Vandalism

Abstract The paper examines the development of risk management strategies for controlling the problem of vandalism in schools through an active mentoring scheme. A case study is used to demonstrate how a mentor can increase the awareness of the problem of vandalism among pupils, staff, parents and governors

Extending the use of risk analysis in project management

The paper is concerned with the expansion of the role of risk analysis in project management. A broad definition of risk analysis is adopted that involves appropriate identification, appreciation and management of project risks. The possible roles for risk analysis in project management are examined. Initially, risk analysis can assist in accept/reject decisions and project design, and subsequently in the development of risk-management strategies. Where a project involves contracting parties, risk analysis can help to determine the appropriate allocation of project risks. Reasons why risk analysis may not be as widely used as it should be are identified. A critical discussion of these arguments highlights additional aspects of the use of risk analysis in practice.