Letters
Health services administration
Volume 176 - Issue 4

Detecting and reducing hospital adverse events: outcomes of the Wimmera clinical risk management program

Authors:  Kathy M Brown, Humsha Naidoo and Arona E Offenberger

Med J Aust 2002; 176 (4): 192-193. || doi: 10.5694/j.1326-5377.2002.tb04362.x
Published online: 18 February 2002
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To the Editor: On reviewing the results of the Wimmera clinical risk management program,1 we are prompted to ask whether the model can be generalised to a tertiary hospital. The program outlined by Wolff and colleagues is a good model for local quality improvement and provides a foundation for developing a model for tertiary hospitals. However, in considering its applicability to tertiary hospitals, a number of issues must be addressed.

The number of separations and emergency department presentations at tertiary hospitals does not lend itself to review of all medical records. Such review is time- and resource-intensive and probably unrealistic in a tertiary setting. A sampling strategy might be more suitable, but would introduce the possibility of sampling error and missing adverse events.

The availability of medical staff to review records is also limited, with clinicians often having public, private and teaching commitments. It would also not be feasible for a medical director to be involved regularly in the day-to-day tasks of the process. Nevertheless, these issues could be addressed by allocating the review process to a dedicated, trained team. Development of a review pathway would ensure participation of senior medical or management staff when necessary.

The interface between tertiary hospitals and local general practitioners is broader and less defined than in rural areas, making the involvement of GPs difficult.

The clinical mix and complexity of patients requiring tertiary care differ significantly from those at a rural base hospital, and restricting screening criteria for adverse events to eight items, as in the Wimmera program, would likely result in adverse events being missed. In addition, the clinical structure of tertiary hospitals is not uniform, and specific criteria may need to be developed to address the clinical specialties of the hospital.

Lastly, in this era of cost containment in healthcare, Wolff et al did not address the cost of its clinical risk management program. While this is not a fault in the study, cost would be an essential consideration in generalising the program to a tertiary hospital.

The model used in the Wimmera program has limitations when considering adaptability to tertiary hospitals, because of issues of scale and day-to-day practicalities. Further examination of the costs involved in ongoing operation of the program and a cost–benefit analysis are required. In addition, investigation is needed into feasible options that deliver useful results in a tertiary setting before a quality improvement model can be developed that is relevant, appropriate and cost-effective for tertiary hospitals.

Authors

  • Kathy M Brown1
  • Humsha Naidoo1
  • Arona E Offenberger1
  • 1. Intensive Care Unit, Frankston Hospital, Melbourne, VIC.
  • 2. Clinical Services, Austin and Repatriation Medical Centre, Melbourne, VIC.
  • 3. Department of Human Services, Melbourne, VIC.

Correspondence: arona.offenberger@dhs.vic.gov.au

References

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