Risk management in hospitals

Hospitals carry a natural amount of risk in their operations: both clinical, and non-clinical risk. While there exist the apparent clinical risks such as infections, wrong medication, wrong surgery etc, there also exist non- clinical risks such as fire, chemical spillage, electrical hazards etc.

Risk management is an important part of Quality Management and Patient Safety activities in hospitals. The US National Library of Medicine’s controlled vocabulary thesaurus,  MeSH, defines Risk Management as “ the process of minimizing risk to an organization by developing systems to identify and analyze potential hazards to prevent accidents, injuries, and other adverse occurrences, and by attempting to handle events and incidents which do occur in such a manner that their effect and cost are minimized. Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability.”

The management of risks require a proactive approach consisting of  Risk identification, Risk assessment, Risk mitigation, Problem Prioritization, Risk reporting , Risk management, Investigation of adverse events and  Establishment of a safe organizational culture.

An incident reporting policy is required. An important part of risk management is the reporting system for incidents such as adverse events , sentinel events and near misses. Sentinel events, which are events not related to the primary illness, resulting in patient death/ permanent loss of function, may include serious injury such as  loss of limb or function. The number of sentinel events are to be  monitored on a monthly basis and reported to the Quality Steering Committee. Patients are assessed at admission for risk of adverse episodes such as falls, and proactive measures are taken accordingly. It is recommended that the incidents are analysed and  analysis is done , including Root Cause Analysis for Sentinel events. This analysis is used to redesign /modify processes or carry out corrective/ preventive steps.

“Safety First” programme is implemented in many hospitals for vulnerable patients

(patients<16 yrs/ >60 yrs, women in labour, critical care patients, patients unable to perform ADL). In addition, the following patients/ processes are high risk and departmental level precautions are to be taken: Patients undergoing surgery, sedation, blood transfusion, chemotherapy, dialysis.

For long-staying patients, medical board is to be held and communication is to be carried out with the patient’s relatives.

Failure Mode and Effects Analysis (FMEA) is a technique used for proactive risk reduction. It consists of the computation of a RPN ( Risk Probability Number) , which is arrived at by multiplying Severity (S), Occurrence (O) and Detection ( D), i.e. S X O X D. It can be used for a variety of problems such as Medication Errors (MEs), Needle Stick Injuries ( NSIs) etc.

According to Hippocrates, the father of modern medicine, the basic principle of medicine should be “ Primum non nociere” , i.e. “ First do no harm.” Keeping this in mind, Risk management is an activity that should be proactively carried out by hospitals.