The Clinical Indemnity SchemeNational Clinical Incident

Reporting system.

Dr.Ailis Quinlan, Head Clinical Indemnity Scheme

OECD Health Care Quality Indicators Seminar on improving
Patient Safety Data Systems. June 29th. 2006

Clinical Indemnity Scheme

Objectives
To drive and support a patient safety culture
To reduce the number of clinical claims
To manage clinical claims in a cost-effective
and timely manner

CIS-Who does it cover ?

87 Enterprises to date
Health Service Executive / Statutory Body
Public Voluntary Hospitals
Other Agency commissioned to provide clinical
services to eligible patients
66,000 staff

CIS-What does it cover ?

Professional Medical Services
(a) Services provided by Registered Medical Practitioners or
Registered Dentists of a diagnostic or palliative nature, or
consisting of the provision of treatment in respect of any illness,
disease, injury or any other medical condition.
(b) Services provided by other health professionals in the
performance of their duties.
(c) Services connected with the provision of health or medical
care provided by persons acting under the direction of the
persons to whom (a) or (b) applies.

Age group

Population Republic Of Ireland, 2002

65+
60-64
55-59
45-54
25-44
20-24
15-19
0-14
0

500,000
Male

1,000,000
Female

Total Pop. 3.9m. - Census 2002. CSO, Ireland

(Est. 4.2m-2006)

1,500,000

Clinical Risk Management Statistics RoI

HIPE* Data 2004
Day cases = 423,031
In-Patients = 560,419
Total
= 983,450

Harvard 4% adverse events

Australian Study 16% adverse events
Expect 37-150,000 clinical incidents per annum
from acute sector
* Hospital In-patient Enquiry System

Statutory Duty of Enterprises

Reporting of adverse incidents to the SCA
Furnish relevant information
Preserve relevant evidence
Permit and facilitate SCA investigation

STARSweb-National Clinical Incident

Reporting System
Web-based clinical incident reporting system

-Electronic, highly secured, confidential

-Adverse events and near misses
-National Rollout of system

STARSweb-Data related Issues

Confidentiality/Security
Virtual Private Network (VPN)
Encrypted data
Digital certificate downloaded on personal PC and
renewed every 12 months
Password protected-forced to change every month
Discontinuance of session-if no input in 15 minutes
Each enterprise can access only its own data

STARSweb-Data related Issues

IT Connectivity
Internet
Large enterprises-High speed leased lines
Smaller enterprises-Broadband

STARSweb-Data related Issues

Data quality assurance
Development of Q/A tool.
Training in Data entry
Train the Trainers curriculum developed .

STARSweb-Data related Issues

Stakeholder consultation
Ongoing opportunity for feedback from end-users

STARSweb Users Forum

STARSweb-Data related Issues

Compliance with Legislation

Freedom of Information
Data Protection

STARSweb-Data related Issues

Buy-in by Healthcare professionals
Likelihood of reporting Incident
Midwives more likely than doctors.
Junior staff more likely than senior.

Vincent, Stanhope, J Eval Clin Practice 1999; 5 (1):13-21

STARSweb-Data related Issues

Buy-in by Healthcare professionals
Reasons for not reporting:
Fear of blame
High workload.
Belief that incident did not warrant report.
Solutions
Simplified methods of reporting
Clear definitions
Education.
Feedback
Reassurance to staff re purpose.
Vincent, Stanhope, J Eval Clin Practice 1999; 5 (1):13-21

Recommended OECD Dataset on STARSweb

General incident type captured
Hospital Acquired infections
Operative and Post-operative complications
Complications of Anaesthesia
Obstetrics
Patient falls

Recommended OECD Dataset on STARSweb

Sentinel Events Captured
Wrong site surgery.
Retained instruments/material post-op. requiring further surgery.
Medical equipment related adverse event.
Haemolytic blood tranfusion reaction due to ABO incompatibility.
Medication errors inc. those leading to death of patient.

Recommended OECD Dataset and STARSweb

General incident type, e.g., Complications of Anaesthesia
Specific nature of event,
Anaesthetic awareness
Problematic intubation inc aspiration/dental damage
Mendelsohns Syndrome
Post-operative pain
Equipment failure/malfunction
N.B. Not possible to capture Post-operative nausea

Progress to date
Over 64,000 clinical incidents / near misses
logged on the live system to date

35%

Breakdown:
45%

Slips, Trips & Falls

Treatment incidents
Medication incidents
Other

9%
11%

Active claims by type adverse event. N=1,700

Slips/Trips/Fall
5%

Consent/confide
ntiality
6%

Medication
3%

Others
9%

Peri-op. / periprocedure
24%

Treatment
11%
Peri-natal
11%

Not Specified
13%

Diagnosis
18%

Integrated Clinical Risk Management/

Claims Management
Enterprises

Clinical
Indemnity
Scheme

Incident
Clinical Risk
Manager

STARS

Clinical Risk
Adviser

Clinical Claims
Manager

STARSweb-Use of Data
CIS will disseminate best practice
information/lessons learnt throughout the
Enterprises
Annual conference/workshops
Website
Newsletter
Training

Thank you.