Clinical risk management in high-volume cataract surgery

Background: The common tenor is "Where wood is chopped, splinters must fall". Too fast human errors will be identified as the cause of an error. But in most cases the errors are located in the system. In 1999 it was the first time that such cases have been worked out in an scientific study by the World Health Organization (WHO). Since then much has happened in this sector. Meanwhile in recent studies was demonstrated that a significant reduction of errors can be achieved by using appropriate measures. Material and methods: As a part of the recertification of the model "Cooperation for Transparency and Quality in the Health Care Sector" (KTQ) a project was implemented in the Saint John of God Hospital in Linz to get more patient safety. Content of this Project are the correct identification of patients, the secured communication among the treatment team and the Team Time Out before surgical interventions. The "Surgical Safety Checklist" used by the WHO served as a template and was adapted. Furthermore a Critical Incident Reporting System (CIRS-System) was integrated in the computer system of the entire hospital. Results: A double check of patient identity was set up to improve patient identification. Furthermore one checklist concerning preoperative preparations was developed, a second one was designed to be used directly before surgery. The introduction of a CIRS-reporting system should help us to identify future problems and to take appropriate measures. Conclusions: The successful implementation of risk management is an extensive process in which many factors must be considered. Involvement in this process is including executives, a adequate resource planning, a comprehensive trial period with the opportunity to revise the results critically, a course for the team and a training phase. A challenge is the introduction of the CIRS-System. The reason is that no one likes to admit his own faults and furthermore nobody likes to name his own col-leagues. There was a change in employees minds necessary. In addition to the trainings especially executives were required to set a good example to have a chance to get the system trough. The clinical risk management has the potential to reduce the trap of risk "human failure" considerably. Another challenge is the evaluation of the results. Quality standardization programs like the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) are basically unsuitable and even the CIRS-system currently can't take over this quatitative task. Nevertheless the reduction of reported claims are used as a measure to report the success of riscmanagement.