Oregon Patient Safety Commission - EDR
Transcription
Oregon Patient Safety Commission - EDR
4/27/2015 EARLY DISCUSSION AND RESOLUTION Bethany Walmsley Bud Pierce Melissa Parkerton Mark Bonanno Bethany Walmsley, Executive Director, Oregon Patient Safety Commission THE COMMISSION’S COMMITMENT TO SHARED LEARNING Oregon Patient Safety Commission Improve patient safety by reducing the risk of serious adverse events occurring in Oregon’s healthcare system and by encouraging a culture of patient safety (§442.820). Quality Improvement and Disseminating Best Practices 1 3 Early Discussion and Resolution 2 Patient Safety Reporting Program 4/27/2015 3 1 4/27/2015 Patient Safety Reporting Program A confidential and voluntary program for healthcare facilities to report adverse event investigation findings and action plans • Understand why and how adverse events occur • Share aggregate information to improve healthcare in Oregon • Identify and share evidence-based prevention practices to improve patient outcomes • Promote quality improvement by convening statewide groups to address serious patient safety issues and providing educational programs in patient safety and quality 4/27/2015 4 Bud Pierce, MD Co-Chair, Task Force on Resolution of Adverse Healthcare Incidents TRANSPARENCY FOR PATIENT SAFETY Honest, Proactive Communication • It’s the right thing for patients • It’s the right thing for providers 4/27/2015 6 2 4/27/2015 Strategies for Disclosure A case study 4/27/2015 7 Melissa Parkerton, Director, Early Discussion and Resolution EARLY DISCUSSION AND RESOLUTION (EDR) OVERVIEW AND STATUS EDR Overview 4/27/2015 9 3 4/27/2015 EDR Status • 22 notices received* • 32% filed by facilities • 68% filed by patients • Consultation provided by phone and email • Presentations provided to associations, boards, facilities, and community groups • Peer Support Development Program attended by 65 participants • First annual report to be published in the fall *As of April 24, 2015 4/27/2015 10 Participation Tips • If you work at a healthcare facility*, make sure an EDR Manager has been designated • If you do not work at a healthcare facility, designate someone within your organization to manage EDR notices and notify the Commission • Consider putting a clear policy in place that integrates EDR into current practices • Educate your healthcare providers about EDR and how you can support them so they aren’t scared when named in a notice *Hospital, ASC, nursing facility, dialysis facility, or birthing center 4/27/2015 11 Participation Tips • Respond quickly when patients file notices even if you do not intend to participate • Develop a peer support program • Consider in-house disclosure training • Call the Commission for help with any concerns or questions 4/27/2015 12 4 4/27/2015 Learn More edr.oregonpatientsafety.org 4/27/2015 13 4/27/2015 14 Provider Resources Mark A. Bonanno, JD MPH General Counsel and Director of Health Policy Oregon Medical Association THE LEGAL GRAY AREAS OF EDR 5 4/27/2015 Confidentiality The issue: EDR statute only protects “discussion communication” made in the course of discussion of an adverse health care incident, and there will be procedural questions about timing of discussions, materials prepared for and the content of discussions, and subsequent challenges to the protections. What you should know: During the EDR process, written or oral communications made in the course of EDR discussions are: not an admission of liability, not admissible, and confidential. Be careful with contradictory statements, material prepared before or after the statutory process, and discussions before or after the process. 4/27/2015 16 Reporting: Databank The issue: Payments by carriers in medical malpractice cases generally are reported to the National Practitioner Databank (NPDB), and EDR raised some legitimate questions about reporting. What should you know: The April 2015 NPDB Guidebook provides (clearer) guidance http://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp 4/27/2015 17 Reporting: Databank NPDB Guidebook Chapter E 8. Following an unsuccessful course of treatment, a patient and a practitioner enter into a State-sponsored voluntary series of discussions in an attempt to settle their disagreement before resorting to litigation. The discussions lead to the practitioner’s insurance company making a money payment to the patient to settle the dispute. Should this money payment be reported to the NPDB? “It depends. If, during the course of discussions, the patient made a written complaint or written claim demanding a monetary payment for damages, the payment must be reported. If the complaint or claim for damages was never put in writing, the payment is not reportable.” 4/27/2015 18 6 4/27/2015 Reporting: Medical Board The issue: In addition to federal reporting questions, state licensing board questions have been raised too. For example, medical boards generally ask questions about settlements of claims or potential claims in their standard renewal questionnaires for licensees. What you should know: The EDR statute does restrict a licensing board from asking a provider about an EDR notice or using the fact a notice was filed as the basis for disciplinary action. 4/27/2015 19 Reporting: Medical Board EDR Statutory Language “A regulatory agency, licensing board, healthcare facility, health insurer or credentialing entity may not ask the Commission, a healthcare facility, a healthcare provider or other person whether a facility or provider has filed a notice of adverse health care incident or use the fact that a notice of adverse health care incident was filed as the basis of disciplinary, regulatory, licensure or credentialing action.” 4/27/2015 20 Communication The issue: Providers raise questions about how to engage in EDR discussions because they have been trained to disclose very little to patients or are uncomfortable with the difficult conversations involving disclosures. What you should know: EDR mostly is about effective communication between providers and patients. Providers need to learn to be fact-based in discussions, respectful and sincere in their demeanor, and do more listening to rather than talking to patients. 4/27/2015 21 7 4/27/2015 Reform Landscape The issue: EDR raises general questions about medical malpractice reform and whether it is the right vehicle for reform. What you should know: EDR is one tool in the toolbox that addresses patient death or serious injury in a respectful manner, and if conducted effectively, can reduce liability exposure and costs in both time and money to bring matters to meaningful closure. 4/27/2015 22 OMA Resources • OMA Website resources http://www.theoma.org/node/3807 • OMA Medical-Legal Compliance Team Contact Mark Bonanno or Danielle Sobel at (503) 619-8000 4/27/2015 23 4/27/2015 24 8 4/27/2015 Learn More Oregon Patient Safety Commission edr.oregonpatientsafety.org [email protected] 503-928-6158 4/27/2015 25 9