Are You Safe? Overview

More and more, health care is delivered at an office-based setting. For patients, clinicians, and non-clinical staff, the safety culture and systems underlying office-based care varies significantly from inpatient care—and from one practice to another.

Through its Office Practice Evaluation (OPE) program and analysis of medical malpractice case data, CRICO and its primary care community identified six key safety principles in primary care. In concert with clinical experts and experienced office-based providers, CRICO produces Are You Safe? to help practices understand and address potential risks to patient safety via malpractice data and case examples.

The Are You Safe? case studies are designed to help all members of the team reduce the risk of patient harm in the course of diagnosis and treatment. Office-based events that trigger malpractice cases present valuable opportunities to identify vulnerabilities in communication, clinical judgment, and patient care systems. Are You Safe? is designed to meet the following objectives:

• Highlight common office-based malpractice risks
• Explore areas of improvement in your practice

Focus

Are You Safe? cases are being developed for specific risks organized under a broader outline of six key safety principles in primary care:

1. Establish and sustain a culture of safety
2. Build and support effective teams
3. Partner with patients and families in their care
4. Ensure closed-loop processes for referrals and tests
5. Develop systems for reliable diagnosis and delivery of evidence-based care
6. Standardize communication among all care providers

Each Are You Safe? case study focuses on a single area of risk, but addresses issues that arise across a range of patient presentations, diagnoses, and clinical scenarios.

Using the Are You Safe? Case Studies

Download a PowerPoint

In addition to the two-page worksheet, CRICO has produced presentations for use by providers and practice staff interested in sharing one (or more) of the Are You Safe? case studies with colleagues. The PowerPoint presentations include additional data and complementary information. Are You Safe? presentations can be found in the Resources for Presenters page.

Additional Resources

For each Are You Safe? case study, additional related materials developed by CRICO and other leaders in patient safety are made available on our website: www.rmf.harvard.edu/areyousafe. These include:

1. CME bundles: samples
2. Podcasts: samples
3. Clinical decision support tools: samples
4. Patient Safety Alerts newsletters: samples
5. Additional case studies: samples

Participation and Feedback

CRICO hopes the Are You Safe? case studies will help raise awareness about the patient safety issues that most commonly put patients and providers at risk. We know that you are our best source for what does and does not work in everyday practice, and we encourage you to share your ideas, concerns, and innovations with us and your peers across the CRICO-insured community.

Email comments, resources, or questions to [email protected].

Case Study Components

Closed Malpractice Cases

The Are You Safe? case examples are drawn from actual events. Every case in the CRICO database is coded to catalogue what happened, and why. The provider-based and systems-based factors that led to the allegation of malpractice are the underpinning of CRICO’s patient safety initiatives, and drive the case selection process.

Patient Safety Vulnerabilities

For each malpractice case presented, the Are You Safe? case study identifies two or three key vulnerabilities exposed by the event. For each, safer care recommendations are included. These vulnerabilities and recommendations are designed to guide the risk assessment process for individuals or teams reviewing each module.

Data

Our goal is to present data and case examples that help caregivers anchor the underlying issues that pose risk to patients and providers. The data are drawn from malpractice cases filed against CRICO-insured providers as well as from our national comparative benchmarking system (CBS) repository of more than 350,000 claims and suits.

Quick Assessment: Could it Happen Here?

Each Are You Safe? case study features a quick assessment: 4–5 questions related to the closed malpractice case and the underlying patient safety issues. While each features topic-specific questions, all begin with “Has this type of event happened at our practice?” Providers and practice staff can complete the quick assessment either individually or, ideally, as a team.

Improvement Opportunities

Each Are You Safe? case study offers members of a practice or care team the opportunity to assess how their systems and protocols align with recommended practices. For those instances where there is a worrisome gap between the current state and a recommended practice, this exercise provides a chance to discuss how to close that gap.

Improvement Opportunities Matrix

Each Are You Safe? case study includes a list of recommended practices related to the patient safety vulnerabilities identified in malpractice data and case examples. Practices are encouraged to compare their current practice to the recommended practice and, if necessary, explore possible improvements.

• Recommended Practice: Most often, the “recommended practice” is a general concept rather than a specific tool or methodology. This enables providers and practices to focus on the intended result rather than the approach. While the CRICO Are You Safe? case studies offer suggestions for assessing and addressing patient safety, they should not be construed as a standard of care.
• Current State: For the gap analysis to be productive, the current state (how we do things now) should be compared to the identified recommended practices. To be most dynamic, this should be explored from a variety of perspectives—either by soliciting input from a cross-section of clinical and non-clinical staff, or via group discussion.
• How to Improve (if necessary): While some improvements may lend themselves to a quick fix, practices are likely to identify issues that require more time and thought. Addressing one issue at a time might be more productive than taking on too many improvements at once.

Disclaimer: The CRICO Are You Safe? case studies offer suggestions for assessing and addressing patient safety and should not be construed as a standard of care.

CRICO’s mission is to provide a superior medical malpractice insurance program to our members, and to assist them in delivering the safest health care in the world. CRICO, a recognized leader in evidence-based risk management, is a group of companies owned by and serving the Harvard medical community.