Ph D thesis Theory and practice of in-hospital patient risk management

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My doctoral thesis Theory and practice of in-hospital patient risk management (ISBN = 90-808149-1-1, 402 pages, includes CD-ROM and index) can be ordered by sending an email to Dit e-mailadres is beschermd tegen spambots. U heeft JavaScript nodig om het te kunnen zien. The thesis costs 35 euros, not including shipping costs.

Contents

Summary

All kinds of factors can lead to undesirable consequences for patients, or to incidents and complications. For effective quality management in hospitals, the registration and analysis of incidents and complications are necessary. In order to gain an insight into the origin and registration of incidents and complications, two models have been developed.

This research focuses on the development and testing of several risk management tools and methods with the aim of pursuing effective risk management. For this purpose, a framework for these tools and methods was designed, using retrospective, real-time and prospective methods. The tools and methods were used in the function group Operating Room (OR) and in the Haemodialysis department of the Catharina Hospital in Eindhoven, the Netherlands, and included:

• A model, based on concepts from system theory, of the processes taking place in a department, which can be used with a Failure Mode and Effects Analysis (FMEA). Of both the function group OR and of the Haemodialysis department, a process model was created.
• An FMEA (prospective method). An FMEA was used to assess the risks for patients in both the OR and in the Haemodialysis department.
• A number of Critical Incident Interviews (retrospective method). Two rounds of interviews were held: 20 interviews in the OR, 25 interviews in the Haemodialysis department. Causal Tree Analysis was used for the processing of these interviews.
• Voluntary incident reports (real-time method). In the OR, a voluntary incident reporting and management system was designed and implemented. The result was a database containing more than five hundred reported incidents collected over less than two years.

The results of this research are not only the found causes of incidents and the opportunities for reducing patient risks, but also the performance of the tools and methods used. The research shows that, after patient risks had been identified, it proved difficult to implement improvements, mainly because the management was not ready for it. All the tools and methods used in this thesis can be applied in other hospitals.