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Enhancing Primary Care Through Critical Event Analysis: Insights from Paraparaumu Medical Centre

This presentation discusses the integration of Critical Event Analysis (CEA) within primary care at Paraparaumu Medical Centre, emphasizing its role in quality improvement and patient safety. It outlines the practice structure, the framework of quality indicators, and the incorporation of CEA into team meetings. Examples of critical events are presented, showcasing both problems and solutions. The advantages of CEA in small team settings, continuous improvement processes, and feedback mechanisms are highlighted, along with future directions for practice enhancement.

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Enhancing Primary Care Through Critical Event Analysis: Insights from Paraparaumu Medical Centre

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Presentation Transcript

  1. Critical Event Analysisin Primary Care RNZCGP Quality Symposium Wellington 2009

  2. Introduction • Practice structure • Integration with other quality activities • Examples • Future directions

  3. Paraparaumu Medical Centre • 3 Practice teams • 4500 patients • Established for 20 years – previous practice for about 20 years prior to that. • Middle SES • 2 main age groups • Elderly • Young families

  4. Framework of Quality at PMC • Cornerstone – accreditation • PHO reporting-immunisations, cervical screening • Patient satisfaction survey – twice a year with registrars • Own audits and goals • Peer review – doctors, nurses, receptionist meetings • Standardised procedures • Clinical (advanced forms) • Non-clinical

  5. Weekly Team Meetings • Balanced scorecard • Week 1 – Staff • Week 2 - Patients • Week 3 – Internal Processes • Week 4 - Finances

  6. Critical Event Process • Fits into the weekly meeting cycle • Team process – team solutions • Simple • Informal – but not unplanned • High face value • Non- judgemental • Potential and actual events (before the event) • Not time consuming • Process based • Time frame for review

  7. CHARACTERISTICS OF PRIMARY CARE CRITICAL EVENT ANALYSIS • Advantages • Small team size • Control over all aspects of the process • Broad definition of critical event • Continuous improvement process • all events trigger a review of process and a review time • Potential and actual events • Before the event (vs audit) • Appropriate to business size • Local problems and local solutions • Evolutionary

  8. Disability Forms • Problem – disability form lost • Review • Multiple processes • Multiple places to put the forms • No defined timeframes • Solution • Clearly defined process • Forms collected • Logged • Put in a folder • Written up Monday lunchtime • Available for collection Monday afternoon • Measure • Number of lost forms and time spent searching

  9. INR testing • Problem – patient not tested for 2 months • Solution • Add a recall when patient phoned • When recalls reviewed missing patients identified • Further activity • Audit of warfarin dosing using BPAC resource • Adding diagnosis, INR range and treatment time to an alert in patient notes • Measure • Audit and number of missing INR’s

  10. Child appointment • Patient rang for appointment for infant • Relieving nurse • Doctor short • Receptionist • ascertained this was not and emergency • told the mother that the child would be seen • Told mother to leave message on nurses answer phone

  11. Child Appointment (2) • Message left on nurses answer phone • Nurse called back in 20 minutes • Mother had taken child to another provider • Child admitted to hospital with viral infection • Felt we could do better • Talked to mother, receptionist, nurse • Revised then process and clarified the message to patients • Measure • patients seen by other providers • Patient satisfaction survey

  12. Broken Nose • 15 year old • Fractured nose at sporting event • Seen at an A&M – xray • Presented Monday morning • Rang ENT registrar • Faxed referral • Told appointment would be on Wednesday • 5 weeks later letter of apology

  13. Broken Nose (2) • Reviewed our process • Clearly communicate our expectations to the patient and to ask them to call up if there were any problems • Difficulty – lack of forum to discuss this critical event • Measure • Further similar critical events

  14. Requirements • All the team involved • Everyone can comment • Regular meetings – continual focus • Specific to local needs – not PHO or DHB although some critical events cross boundaries • Clear face value validity Improving patient care • Simple methods – root cause, 5 why’s – “What is really going on?” • Clear systems which can be adapted and continuously improved • IT platform

  15. Has it made a difference • Team says – “Yes” • Management efficiency • Clinical improvement • Hard to quantify but qualitative analysis is positive

  16. Future Developments • Within practice • Increasing clinical focus • More critical events in peer review and nurses meetings • Clearer linkage between standardised process, audit and critical events • Measuring the effect of critical event analysis

  17. Wish list • Resources for critical events • Interaction with other levels of critical events • Analysis of effectiveness of methods of critical event review

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