/clinical/,/clinical/patient-safety/,/clinical/patient-safety/psn/,/clinical/patient-safety/psn/heet/,

/clinical/patient-safety/psn/heet/

201710278

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100

UWHC,UWMF,

Safety,

Clinical Hub,Patient Safety,PSN Event Reporting

Event Evaluation Teams

Event Evaluation Teams - Clinical Hub, Patient Safety, PSN Event Reporting

Focus

HealthCare Event Evaluation Team (HEET) covers Inpatient/Procedural and Ambulatory
Safety Event Assessment Team (SEAT) covers American Family Children’s Hospital (AFCH)

Purpose: To provide a triage function for the investigation of health care incidents reported through the organizational event reporting system and by other mechanisms.

AFCH/Inpatient/Procedural and Ambulatory Teams meet on a regular basis to review event reports with a focus on:
a. High harm scores
b. Repetitive events
c. Potential sentinel events
d. Complicated/patient/family complaints regarding quality of care
e. Potential litigation
f. Unsafe conditions
g. Near misses

Teams are multidisciplinary and responsible for facilitating further review of events with the goal of assuring issues are addressed by the appropriate administrative unit(s) that can most effectively identify opportunities for system performance improvement.

a. Identify FMEA/Proactive Risk Assessment (PRA) opportunities.
b. Determine Sentinel Event status for those events that require a RCA.
c. Determine when causal analysis of non-sentinel events should be performed.
d. Oversee the UW Health Good Catch Program where selected staff receives recognition for making a recommendation or for catching a mistake before it reaches a patient/staff/visitor and reporting it through our event reporting system.