Contents Legal system Malpractice Avoiding malpractice Physician-patient Truth and duty Privacy & confidentiality Off. Risk Management FAQs Medical record Patients' rights QUIZ

YNH Hospital Office of Risk Management The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the preeminent organization which accredits hospitals in the U.S., began its interest in risk management at the same time that the Health Care Quality Improvement Act (HCQIA) of 1986 established the National Practitioner's Data Bank (NPDB). HCQIA established guidelines that conferred immunity from legal action for good-faith peer review activities if certain criteria were met. This act encouraged the Health Care Financing Administration (HCFA), the governmental organization which administers Medicare, to continue developing local peer review organizations (e.g. Connecticut Peer Review Organization, or CPRO) which are intended to monitor quality of care and hospital use among Medicare patients. With the explosion of peer review and interest in quality assurance/improvement, many states, Connecticut included, adopted risk management reporting systems; specifically, Connecticut's requirements state that a hospital must report to the state when it begins action against a physician to restrict clinical practice for clinical reasons. The state may then investigate the provider. Increased insurance costs, combined with the "malpractice epidemic" and the above legislation has led to the proliferation of Hospital Risk Management Offices. Offices of Risk Management are concerned with a wide range of issues, however the overall goal is improvement of the quality of care and to eliminate or minimize the number of accidents with an eye towards claims prevention. Goals of the YNHH Office Risk Management: 1. Decrease severity and number of patient and visitor injuries by: receiving and reviewing incident and occurrence reports, as well as patient/visitor complaints. working closely with quality assurance/improvement committees. periodically reviewing credentialling procedures. being involved in the education of medical staff and employees via grand rounds, inservices and other venues. 2. Assure that documentation of care is adequate by: working closely with medical record committee. educating medical staff and employees. 3. Limit financial loss related to clinical care and provide a mechanism to deal fairly with issues related to claims from adverse outcomes in clinical care. The office: investigates professional liability claims (i.e., malpractice) and negotiates fair resolution manages certain insurance policies which have been secured by the hospital and its employees