Clinical Risk Management in Italy
State of the Art
Riccardo Tartaglia, MD, Ph. D
Clinical Risk Management and
Patient Safety Centre
Regione Toscana
Firenze,
23 Ottobre 2004
WHEN
did the problem arise?
WHY
is it important to act?
WHO
is involved?
WHAT
are our plans ?
HOW
can we enhance patient safety?
WHEN did the problem arise?
The problem of medical errors has always
existed but in these last 5 years it bursted
- Rapid increase of insurance costs
- The patient-doctor relationship has changed
and expectations of cure both in quantity and
quality have increased in recent years
- Scientific literature reports a high number of
deaths due to medical errors (Institute of
Medicine, 2000)
WHY
is it important to act?
 Primum non nocere
 The number of lawsuits has increased. In Italy
there are about 12,000 per year (2002), but only
5000 healthcare professionals are condemned
(CINEAS - Consortium for insurance engineering)
 In Italy insurance costs have sensibly increased
and, for example, in Tuscany these costs for
hospitals are estimated about € 31.500.000
 CINEAS estimates between 15.000 and 50.000
the number of deaths due to medical errors in
Italy
 Patient injuried parties claim for an amount of
2.5 billions € in compensations
WHO
is involved?
The departments or wards with the highest
number of lawsuits are:




Orthopaedics 16.5%
Oncology 13.0
Surgery 10.6
Gynaecology 10,8
(Cittadinanza attiva, Italy 2002)
WHAT
are our plans ?
 Promote a reporting and learning culture
 Create a database of adverse events/alert
reports (volontary incidents reporting) for an
organization with memory
 An organization based on memory through a
Clinical audit as an educational instrument
for clinical risk management
 Information campaigns on specific issues for
patient safety implementation (wrong site
intervention, hospital infections, patient
identification, and medication therapy)
 Develop usable ICT for healthcare systems
(electronic records, alert systems, wireless
devices for therapies subministration,
hospital information systems)
HOW
can we enhance patient safety?

Involving healthcare top management

Promoting a reporting and learning culture through
informational sensibilazation

Promoting clinical audits on sentinel and adverse
events, unsure actions among all the areas involved

Ensuring the presence of Clinical Risk Managers in
every hospital (doctors, nurses or other professionals
with a specific training in human factor)

Training specific personnel in risk management

By means of the guidelines for patient safety
enhancement promoted by the Italian Healthcare
Ministry (cognitive approach)
A view on the Italian
experiences
 “Palmhospital” computerized Phisicians Order Entry by





palmar vs HWP in 17 infective diseases wards of
Lombardia Region
Regione Emilia Romagna, Regional Agency for Health:
pilot study of voluntary reporting systems
Regione Toscana, Azienda Sanitaria di Firenze (4 hospitals
in Florence): clinical audits as a method to improve
patient safety (a voluntary reporting system) and two
campaigns: cleaning hands for preventing hospital
infections, and to avoid the trascription of therapy from
clinical records to other forms (unified therapeutical
form)
Certified clinical record ISO 9000 (Niguarda Hospital
Milano)
Regione Lazio, Azienda Sanitaria di Roma: a voluntary
reporting systems
Regione Veneto: hospital discharge record as an
instrument to track errors
Knowing is not enough, we must apply
Willing is not enough, we must do.
Goethe
Thank you for your attention