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Risk management in the emergency department is defined in this article. The health care professional should focus on the health and best interests of the patient.
BACKGROUND: The purpose of this study was to define cardiovascular risk and management in low risk ambulatory patients. METHODS: Case-control, cross-sectional audit of 1806 patients from eight primary care clinics from 1992 to 1994. The case study group comprised 902 patients who had lipid profiles completed within six months of the index audit, and the control group comprised 904 age-, sex- and temporally matched patients with no lipid measurements. RESULTS: The prevalence of cardiovascular risk factors and risk factor management strategies between the cases and control subjects revealed that all risk factors and risk reduction interventions were significantly higher (P < 0.02) among patients with a recent measurement of their serum lipid profile. Logistic regression revealed previous lipid-lowering therapy and history of diabetes or dyslipidemia to be preferentially related to likelihood of serum lipid measurements. CONCLUSIONS: The data suggest that primary care physicians are more aggressive in the investigation of low risk patients with higher prevalence of traditional cardiovascular risk factors, relative to clinically similar patients with lower risk profiles. This practice pattern, based on history-derived risk stratification, is compatible with propagated consensus guidelines on cardiovascular risk reduction and represents an appropriate utilization of health resources by physicians concerned with the prevention of cardiovascular disease.
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Risk management is defined as the systematic process of identifying, evaluating and addressing potential and actual risk. Although introduced to the hospital industry nearly a decade ago, it status in Canadian hospitals remains uncertain, a position that is in sharp contrast to the American situation. Chiefly as a result of the medical malpractice crisis and associated circumstances in the mid-1970s, risk management has emerged as an integral element in the operational activities of American hospitals. The process is a mechanism for self-protection in co-operative, self-insurance arrangements and to secure commercial premium adjustments. Many trends have been recognized in canada that would suggest a predisposition toward the proliferation of risk management programs. These indicators include an increase in the number and size of claims against hospitals and physicians, a reduction in the availability of commercial health care insurance, and an increase in alternative insurance arrangements. Despite these indicators, movement toward risk management by Canadian hospitals has been minimal. A prime reason appears to be lack of financial incentives to stimulate the development of risk management programs. There is also an absence of specific accreditation standards pertaining to such programs. The case in support of risk management for Canadian hospitals continues to grow. The basic assumptions associated with a program are board, medical and staff support; a concerted effort to recognize and reduce potentially litigious situations and occurrences; and an ability to adapt. The initial steps to develop a risk management program include assessing current risk control activities and implementing structural elements. As well, a program must address its relationship to Quality Assurance activities in the hospital.
The purpose of this study was to investigate the efficacy of the patient-based coronary heart disease (CHD) risk management strategy in general practice by analyzing patients who were sent to a specialized center as refractory to conventional treatment. Of the 452 patients studied, 152 were excluded because of secondary hyperlipidemia. The effects of a food protocol-monitored dietary/drug treatment on lipid profiles and CHD risk indices and the compliance to this approach were monitored for 12 months in 300 of 452 patients. CHD risk classification was performed according to NIH criteria by the referring physicians, but secondary hyperlipidemia was not identified and treated appropriately. Physicians did not fully utilize dietary and drug treatment and referred the patients to a specialized center too early. The initiated food protocol-controlled treatment was more efficient than pretreatment in general practice, with a compliance of 80.3% by patients selected according to their CHD risk. Long-term CHD risk reduction was persistent for 12 months in compliant patients; however, a cumulative dropout rate of 43% after 6 months and of 68% after 12 months was noted. Statistical analysis failed to reveal consistent prognostic factors of long-term compliance.
Risk management strategies have been used in a wide range of sports. Many issues involved in the implementation of risk management models in sport have not been investigated especially the sport specific and location specific nature of such models. The aim of this study was to ascertain the usefulness of Occupational Health & Safety risk management (RM) models in a mainly voluntary sporting organisation and to investigate the requirements of a netball population in developing "user friendly" risk management plans. The industry RM plans were trialled in a rural setting at various netball associations over a six week period. After these trials focus groups and interviews were conducted and the trials evaluated. The requirements of the netball population for a RM plan were investigated using focus groups from regional and rural areas. The industry RM models presented were not generally accepted by the trial participants. They found that the level of expertise required did not exist in netball at the club/team level. The focus groups on the needs of netball for a user friendly model brought out a number of issues including the specific needs of rural football/netball leagues, the need to develop strategies for all levels of netball (coach, player, umpire, administrator). Barriers to the uptake of risk management models were discussed. An effective RM plan can be developed for voluntary sports associations but they must be specific to the sport and flexible. The RM plan must also take into account the barriers to implementation for each sporting culture.
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PURPOSE: To assess changes in isotretinoin prescribing following the implementation of the System to Manage Accutane Related Teratogenicity (SMART) risk management program. METHODS: Using nationally representative commercial data resources on prescription drug dispensing patterns, surveys of office-based physician practices, and a large, claims database from a pharmacy benefits manager (PBM), we examined the total number of isotretinoin prescriptions (new and refill), prescriber speciality, and patient characteristics (age, gender, severity of acne indication) in the year before (April 2001-March 2002) and the year following (April 2002-March 2003) implementation of the SMART program. RESULTS: In the 12-months prior to SMART, 1 508 000 prescriptions were dispensed for isotretinoin, declining approximately 23% to 1 160 000 prescriptions in the year following SMART. There was little or no change in prescriber specialty, severity of acne, and patient age and gender. CONCLUSION: SMART may have lead to a decrease in isotretinoin prescriptions. Further research is needed to determine whether the reduced number of isotretinoin prescriptions reflects appropriate use or inhibited use resulting in loss of access to the product's benefits.
Training of physicians in risk management has become an important task for continuing medical education (CME) directors, particularly in states where risk management education is required for licensure. Physicians in Florida who completed an introductory program in risk management were surveyed to determine future topics for risk management education. Physicians identified desired topics using a five-point Likert-type scaling (5 = high priority; 1 = low priority) and rated 55 topics within 10 major subject areas. The means, standard deviations, and rank order of topics within the subject areas are reported. Multivariate analysis of variance (MANOVA) revealed no significant differences between surgeons and non-surgeons with respect to the subject areas. A significant difference, however, was shown, between academic physicians and non-academic (private practice) physicians; non-academic physicians gave significantly higher scores to six subject areas: malpractice, medical records, acts or omissions constituting negligence, negligence/malpractice actions, defenses, and risk management programs. The results suggest that it is not necessary to plan separate risk management education programs for physicians according to their specialty; one should note, however, the higher priorities given by non-academic physicians and consider these differences when planning advanced risk management programs.
The role of risk management is vitally important in the hospital. As institutions grow and the field of health care advances into the future, the number of patient-associated risks will continue to multiply. In response, the Joint Commission has changed its policies to reflect the importance of patient outcomes. This new Joint Commission focus, coupled with the increasing number of patient risks, will create the need for health care professionals to recognize their role in risk management. In anticipation of the future, pharmacy has been guiding itself toward that role for some time. With a large portion of the profession participating in activities such as DUE and QA programs, pharmacists can be a useful resource to the risk manager. Participation in retrospective analysis such as ADRs and peer review committees also aids the pharmacy profession in establishing guidelines that will decrease future patient risks. Future trends in drug development will increase the pharmacist's role in drug selection, in an effort to ensure both safety and cost containment. The profession's continuing development and implementation of practice standards will ensure that pharmacy remains dedicated to improving patient outcomes and decreasing patient risks. In addition, by learning to use the risk manager as both a source of information and a partner in identifying pharmacy-related areas of risk, the pharmacy profession will be able to continue its pursuit of improved quality of patient care.
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BACKGROUND: Despite clear evidence for the efficacy of lowering cholesterol levels, there is a deficiency in its real-world application. There is a need to explore alternative strategies to address this important public health problem. This study aimed to determine the effect of a program of community pharmacist intervention on the process of cholesterol risk management in patients at high risk for cardiovascular events. METHODS: A randomized controlled trial conducted in 54 community pharmacies (1998-2000) included patients at high risk for cardiovascular events (with atherosclerotic disease or diabetes mellitus with another risk factor). Patients randomized to pharmacist intervention received education and a brochure on risk factors, point-of-care cholesterol measurement, referral to their physician, and regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions. Usual care patients received the same brochure and general advice only, with minimal follow-up. The primary end point was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication. RESULTS: The external monitoring committee recommended early study termination owing to benefit. Of the 675 patients enrolled, approximately 40% were women, and the average age was 64 years. The primary end point was reached in 57% of intervention patients vs 31% in usual care (odds ratio, 3.0; 95% confidence interval, 2.2-4.1; P<.001). CONCLUSIONS: A community-based intervention program improved the process of cholesterol management in high-risk patients. This program demonstrates the value of community pharmacists working in collaboration with patients and physicians.
Like most businesses, adjusting companies are not charitable organizations. They are entitled to a reasonable profit, which the risk manager should not begrudge. As a buyer of adjusting services, a risk manager with an inordinate obsession with slashing adjusting bills can destroy the goal of high-quality service. It is best for risk managers to pick and choose the areas for cutting adjusting expenses. To an extent, health care risk managers should view payment of high-quality adjusting services as an investment, with the payback being money saved by fighting fraudulent, exaggerated, and questionable claims.
Risk managers increasingly face having to justify their decisions in allocating limited resources. These decisions may include prioritizing hazards, determining appropriate levels of safety, and identifying and selecting optimal risk reduction strategies. These decisions require making choices among alternatives, choices that may be difficult because they invariably involve trade-offs. Integrating risk assessment and economic analyses can aid decision making by determining the benefits and costs of alternative actions. Risk assessment and economic analysis provide the measurement tools that will facilitate intelligent, informed, risk management and will enable effective and efficient resource allocation decisions.
Risk Management is an important focus in health care today. We attempt to define the term and explore differences between a risk management approach and quality assurance. Occurrence screening is examined and the importance of patient satisfaction outlined. An example of a practical physiotherapy program which incorporates quality assurance, risk management, and utilization review is given.
Managing clinical risk involves all staff with clinical and managerial responsibilities. This article draws attention to some key steps in risk management and ways to deal with the problems when things do go wrong.
Involvement with both risk management and quality assurance programs has led many authors to the conclusion that the fundamental differences between these activities are, in fact, very small. "At the point of overlap, it is almost impossible to distinguish the purposes and methods of both functions from one another." "Good risk management includes real improvement in patient care through organized quality assurance activities." The interface between a proactive risk management program and a quality assurance program is dynamic and can serve the legitimate interests of both. There is little to be gained by thinking of them as separate entities and much to be gained by sharing the lessons of both. If one thinks of risk management in terms of "risk" to quality patient care, and that "assuring quality" is the most productive type of risk management, then there is no practical reason to separate one from the other.
The specific blockade of endocannabinoids at the level of the cannabinoid receptor 1 (CB (1) receptor) is a new therapeutic option to reduce body weight and manage cardiovascular risk. Although clinical trials are underway to document the safety and efficacy of this approach, much is still unknown about this endogenous system. Endocannabinoids and their receptors are expressed in the central nervous system as well as in the periphery and regulate the central neural circuits for food uptake and peripheral metabolic circuits. Within the context of food uptake, the stimulation of the CB (1) receptor with Delta (9)-tetrahydrocannabinol (Delta (9)-THC) enhances food consumption, while its blockade with receptor antagonists is an emerging relevant therapeutic means to reduce body weight. Rimonabant is the first of a new class of drugs that interferes with the endocannabinoid system by blocking the CB (1) receptor. In recent clinical studies, a substantial reduction in body weight and waist circumference was associated with an improvement of the cardiovascular risk profile. In particular, increased HDL cholesterol, decreased serum triglycerides and improved insulin sensitivity were observed. Further research will serve to establish the role of these compounds in cardiovascular risk management.