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  • fto5.ppt

    1. 1. Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base): Current Evidence on Incident Reporting and its Impact to Quality of Care Dr.Theodoros N ArvanitisDr.Theodoros N Arvanitis Kodak/Royal Academy of EngineeringKodak/Royal Academy of Engineering Educational Technology Research GroupEducational Technology Research Group School of Electrical & Electronic EngineeringSchool of Electrical & Electronic Engineering The University of Birmingham, UKThe University of Birmingham, UK Dr.John M RyanDr.John M Ryan Accident & Emergency DepartmentAccident & Emergency Department Royal Sussex County HospitalRoyal Sussex County Hospital Brighton Health Care NHS TrustBrighton Health Care NHS Trust Brighton, UKBrighton, UK
    2. 2. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Critical Incident: a definition  A critical incident is “any event which is inconsistent with routine hospital practice or with the quality of patient care and which has or could have adverse outcome for a particular patient”  J.A. Williamson, (1998),Critical Incident Reporting in Anaesthesia. Anaesthetic Intensive Care, 16: 101-103.
    3. 3. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Incident Monitoring in A&E  Incident Monitoring: A form of clinical action research  allows for the elicitation of appropriate information towards planning of risk management in hospital practice  Incident Monitoring in Accident & Emergency Medicine:  Risk management planning  “Best Practice” guideline and protocol Design  Informing intra-departmental educational activities
    4. 4. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Current Approaches on Critical Incident Monitoring in A&E Practice  Traditionally the responsibility of Risk Management  Paper-based reporting systems  CIM traditionally reactive: incident investigation after the event  Disadvantages:  Time consuming exercise  Lack of Anonymity  Frequently event rather than patient focussed  Most often reported by senior staff  altered perception and outcome bias
    5. 5. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Rational  Need for patient-centric risk management  Need for current evidence on guideline and protocol design  Need for improved reporting mechanisms  Ethical responsibility and shared knowledge  Financial implications  Litigation driven risk management
    6. 6. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Objectives of our methodology  To develop and implement a Web-based reporting system to facilitate the electronic submission of A&E critical incidents.  Such on-line system should: – provide seamless accessibility options – offer an easy-to-use interface – include a relational database for action research
    7. 7. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Methods: Web-based system Client/ html form Email server database Client/ html form Client/ html form parser On-line feedback
    8. 8. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Event-driven Perceived Critical Incidents  Triage error  Did Not Wait  Failure to request an X-ray  Failure to interpret X-ray appropriately  Drug error  Hand over  Failure to admit
    9. 9. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) The CRIME-based Web Site
    10. 10. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) 0 10 20 30 40 50 60 70 80 % Consultant Registar HO SHO Other Reported by Involved In Results(I): Reported vs. Involved Paper Reporting
    11. 11. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) 0 10 20 30 40 50 60 70 % Consultant Registar HO SHO Other Reported by Involved In Results(I): Reported vs. Involved Web-based Reporting
    12. 12. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Where the incidents were identified 0 5 10 15 20 25 30 35 40 A B C D E F G % of incidents per emergency dept room A: Majors B: Minors C: Paediatrics Area D: Corridor E: Emergency Theatre F: Triage G: Short Stay Ward
    13. 13. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Type of complaint 0 5 10 15 20 25 30 35 40 45 Medical Surgical Drug Related Triage % of incidents per type of complaint
    14. 14. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Reasons for Critical Incident 0 5 10 15 20 25 30 35 40 45 A B C D E F G %per reason A: Inexperienced B: Carelessness C: Inappropriate hand over D: Lack of Knowledge E: Too Busy F: Language Barrier G: Other
    15. 15. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Benefits  Evidence of where Critical Incidents occur  Participatory Exercise - Shared information  More appropriate Risk Management  Allow us to re-direct induction courses  Allow us to focus teaching to areas of clinical need  Paperless exercise
    16. 16. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Limitations  Open to abuse  Incidents cannot be validated  Parts of the Report form may not be applicable internationally!  Terminology in Emergency Medicine is not universal  Attitudes of emergency personnel
    17. 17. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Future Plans  Automatic management to preserve anonymity for larger studies  Extended use of agent-based data mining and trend analysis  On-line education programmes based on most frequent critical incidents being reported (already intranet-based multimedia A&E textbook, case of the week, BAEM)  Interactive Emergency Medicine tutorials
    18. 18. MEDNET 99: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base) Summary  Physicians have an ethical and clinical responsibility to learn from their mistakes  An international database of Critical Incidents will allow us focus teaching and risk management appropriately  CRIME-base Brighton is a tool which facilitates reporting of critical incidents

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