Comprehensive Clinical Risk Management in a University Hospital: Implementation, Results and Outcome

Background: Despite the increasing awareness of the need to implement systematic methods to reduce treatment-related risks, there are only few studies on comprehensive clinical risk management (CRM) in hospitals. The aim of this study was to report on the implementation, results and outcome of a CRM system at a university hospital in Tyrol, Austria.MethodsCRM was rolled out in 35 departments of the hospital over a period of nine years and included the training of interdisciplinary risk management teams at each department, external and internal risk audits and the implementation of a critical incident reporting system (CIRS). The results of the risk audits were retrospectively reviewed and the risks identified were analyzed according to the type, severity and degree of implementation of risk management measures. Other key figures of CRM were obtained from the annual risk reports. The development of liability cases in the individual departments and in the entire hospital was used as an outcome measurement.ResultsOf the 1,104 risks identified during the risk audits, 620 (56.2%) were related to the organization of clinical care, 235 (21.3%) to documentation, 169 (15.3%) to patient treatment and 80 (7.2%) to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), and the lowest in the category documentation (13.6%). The degree of implementation of prevention measures after 12 to 18 months was between 69.7% and 83.4% depending on the risk category. The CIRS identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months.Compared with the years prior to the introduction of CRM, an average annual reduction of treatment-related harms by 52.9% (95% confidence interval, 44.2% to 61.6%) was observed at the end of the implementation phase. The mean number of harms per department and year dropped from 7.04 to 3.45 (p<0.001). ConclusionsThe results of this project demonstrate the effectiveness of systematic CRM in detecting treatment-related risks and in reducing harm to patients.