1. The Clinical Indemnity Scheme- National Clinical Incident Reporting system. OECD Health Care Quality Indicators Seminar on improving Patient Safety Data Systems. June 29 th. 2006 Dr.Ailis Quinlan, Head Clinical Indemnity Scheme

2. 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

3. CIS-Who does it cover ? 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

4. CIS-What does it cover 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.

5. Total Pop. 3.9m. - Census 2002. CSO, Ireland (Est. 4.2m-2006)

6. 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

7. Statutory Duty of Enterprises Reporting of adverse incidents to the SCA Furnish relevant information Preserve relevant evidence Permit and facilitate SCA investigation

8. 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

9. 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

10. STARSweb-Data related Issues IT Connectivity Internet Large enterprises-High speed leased lines Smaller enterprises-Broadband

11. STARSweb-Data related Issues Data quality assurance Development of Q/A tool. Training in Data entry Train the Trainers curriculum developed.

12. STARSweb-Data related Issues Stakeholder consultation Ongoing opportunity for feedback from end-users STARSweb Users Forum

13. STARSweb-Data related Issues Compliance with Legislation Freedom of Information Data Protection

14. 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

15. 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

16. Recommended OECD Dataset on STARSweb General incident type captured Hospital Acquired infections Operative and Post-operative complications Complications of Anaesthesia Obstetrics Patient falls

17. 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.

18. 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 Mendelsohn’s Syndrome Post-operative pain Equipment failure/malfunction N.B. Not possible to capture “Post-operative nausea”

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

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

21. Integrated Clinical Risk Management/ Claims Management Enterprises Incident Clinical Risk Manager Clinical Indemnity Scheme Clinical Claims Clinical Risk Manager Adviser STARS

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

23. Thank you.