Security through risk management

A patient entering a hospital facility should not face any avoidable risk during his or her stay.

Avoiding patient errors and harm

To ensure safe and error-free treatment for our patients at EOC hospitals, numerous measures are taken to identify safety-relevant events and introduce measures to prevent errors and harm to patients.

Safety rhymes with appropriateness

The overuse of diagnostic and therapeutic examinations is an increasingly widespread and important phenomenon: in fact, it has long been pointed out that many examinations and many pharmacological and invasive treatments, which are widely used in medical practice, do not benefit patients; on the contrary, they risk being harmful.

"Doing more does not mean doing better." Consistent with this motto-which stems from the U.S.-based Choosing Wisely initiative that has progressively spread internationally-EOC, understanding the importance of this issue from the outset, launched an awareness campaign, coordinated in its first pilot phase by Locarno Regional Hospital, which contributed to the birth of the Swiss Smarter medicine association.

This awareness campaign, which started in 2013, led to reflection on practices at risk of inappropriateness and can be summarized as the desire to safeguard the patient from undesirable consequences of therapeutic measures (e.g., damage from radiation and side effects from some drugs and possible inconveniences related to the diagnostic strategy (e.g., unnecessary blood draws).

In the area of appropriateness, EOC conducted two specific projects :

  • Safety in bladder catheterization, aimed at ensuring that the bladder catheter is placed according to a list of specific indications, is removed as soon as possible, and is managed by properly trained personnel.
  • Patient Blood Management, which emphasizes the appropriateness of blood transfusions in the surgical setting--working on preventing anemia and blood loss in patients--and in the internist setting based on a clear algorithm for managing hemotransfusions.

Preventive measures

Learning from critical issues

EOC facilities have an internal reporting system to systematically detect critical patient safety issues, analyze them and implement the necessary preventive or improvement actions.
The reporting tool makes it possible to learn from adverse events and strengthen the culture of safety within EOC facilities.

Alongside the internal reporting system, other activities are implemented at the EOC, such as:

  • Theperformance of internal audits that, by reconstructing and following the patient's journey within the facility, allow the identification of critical aspects in need of improvement.
  • The periodic review of medical records, conducted in collaboration with physicians and nurses, which makes it possible to contribute to health workers' awareness of risks, thereby supporting behavior change.
  • Mortality and morbidity interviews or clinical case discussions , which allows for the sharing of cases in which management has been particularly difficult or has led to negative outcomes, so as to maintain a constant focus on the levels of risk inherent in the system while simultaneously learning from past mistakes.
Risk reduction

Wherever people work, it is possible for mistakes to happen. The task of health care facilities is therefore to design the organization and processes in such a way as to make the environment within which employees are called upon to act safer.

Within the EOC, specific measures are taken to reduce risk and increase safety, including:

  • Patient identification: consistent with international patient safety goals, at the EOC patients are identified by full name, surname and date of birth. In inpatient settings, as well as in some outpatient settings, an identification bracelet is used to support proper patient identification.
  • Safe surgery checklist: before every surgery performed in the operating block and before every surgery performed in the endoscopy room, a checklist is used to verify the correctness of the patient, surgical site and surgical procedure, as well as whether all necessary preparations have been performed correctly.
  • Hand hygiene: infection prevention is a top priority, and proper hand hygiene is one of the main weapons at our disposal to fight infection. Proper hand hygiene is constantly monitored, and specific actions and training are implemented to increase adherence to the act.
  • Prevention of falls: falls are the most frequent adverse event in health care facilities and predominantly affect frail people. Falls can have an impact from a physical (injury or damage), psychological (fear of falling), economic and social (diagnostic and treatment costs as well as related to possible disabilities) point of view. For this reason, EOC hospitals implement a falls prevention strategy that considers:
    • The assessment and mitigation of environmental risks.
    • The periodic assessment and reassessment of patients' risk of falling.
    • The implementation of preventive measures where necessary.
    • The involvement of the patient and family members.
    • The periodic monitoring and discussion of the results.
  • Structured and effective communication: language lends itself to misunderstandings and errors; poor communication is often one of the causes of errors in health care. Specific tools and methods are therefore adopted within the EOC to ensure that communication is more structured and consequently more effective.
Proactive and interactive learning

Awareness and attention to risks benefits from training that can be performed in a protected setting. With this in mind, we periodically organize "error rooms" and simulations-the latter in collaboration with the CeSi Simulation Center-on different topics, where EOC employees can train their ability to recognize risks.

The English version of this page was created with the aid of automatic translation tools and may contain errors and omissions.
The original version is the page in Italian.