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Ambulatory Risk Management Pilot
Carolyn Wheaton, RN, MS, Beth Israel Deaconess Medical Center, Boston, MA
Susan Cornacchio, RN, JD, Controlled Risk Insurance Company, Risk Management Foundation, Cambridge, MA
Beth Israel Medical Center is a 621 bed academic medical center in Boston, MA which hosts nearly 750,000 outpatient visits
in and around the main campus.
CRICO/RMF is the patient safety and medical malpractice company serving the Harvard medical community.
First Phase: Using Data to Drive Action
CRICO malpractice data showed a steady
increase in the proportion of high-severity cases
in the outpatient setting
The majority of the high severity outpatient cases
alleged delay in diagnosis of cancer
Vulnerabilities in the Process of Care were
closely aligned with risks identified in CRICO’s
Office PracticeEvaluations
CRICO’s Office Practice Evaluation data showed
practices were consistently struggling with health
screening and management of test results and
referrals
Second Phase: Development of an Ambulatory Risk Management Program
The BIDMC’s complex and varied relationships with its ambulatory practices made it an ideal site for the development of a pilot
program that could be widely replicated. An ambulatory risk manager was hired and four sites were chosen:
A large primary care practice based at BIDMC
A healthcare center in a suburban setting
A healthcare center in an urban setting
A neighborhood health center in an urban setting
Education and Outreach
The ambulatory risk manager is focused on:
Establishing relationships with medical directors and practice managers to identify their particular needs and vulnerabilities
Providing ongoing education to reduce risk and improve quality in the ambulatory setting
Meeting in small groups to increase awareness of what to report and how
Working directly with managers and providers to complete event investigations and follow-up
Developing criteria and mechanisms for reporting relevant events to the medical center
Increasing access to and use of the computer based event reporting systems
Adapting features of the reporting systems to better meet the needs of ambulatory settings
Heightening awareness of the significance of “near miss” and “good catch” events
Identifying themes and sharing information across the ambulatory sites
Interfacing with the hospital’s Risk Manager to strengthen the relationship between off site practices and the medical center
Performance Improvement
The ambulatory risk manager is identifying specific loss prevention initiatives. Preliminary targets include critical referral
management and test result management.
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Carolyn Wheaton (<a href="mailto:cwheaton@bidmc.harvard.edu">cwheaton@bidmc.harvard.edu</a>)
Project Team
Carolyn Wheaton<br />Susan Cornacchio
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Safety and Risk Management
Controlled Risk Insurance Company (CRICO)
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ambulatory Risk Management Pilot
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety