Limited Adverse Occurrence Screening (LAOS) program: Annual report 2007-08

Introduction

The Department of Human Services (the department) has a clinical risk management strategy to encourage a systems approach to preventable adverse events and expects all health services to establish a clinical risk management program. All rural communities want to retain local acute care services but it is difficult for a small rural hospital to develop an arms-length clinical risk management program.

Limited Adverse Occurrence Screening (LAOS) is designed to support high-quality care in small rural hospitals and has broken down many of the barriers small rural hospitals have faced when participating in a formal medical peer review.

In small rural hospitals, general practitioners (GPs) working as visiting medical officers (VMOs) admit patients, provide acute services, and participate in after-hours care. LAOS provides small rural hospitals and VMOs with the resources to participate in clinical risk management by confidential peer review, which promotes discussion of adverse events and offers recommendations for improved clinical care. An adverse event is an untoward patient event, which under optimal conditions is not a natural consequence of the patient's disease or treatment.

The department provided funding to roll out LAOS statewide in 2001, based upon a pilot clinical risk management program developed by the West Vic Division of General Practice and has provided on-going funding each triennium. From 2006, the department has funded General Practice Victoria (GPV) to coordinate LAOS, with coordinators working at a divisional level.

The six lead General Practice Divisions managing LAOS at the local level are:

• General Practice Alliance – South Gippsland
• Goulburn Valley Division of General Practice
• Murray Plains Division of General Practice
• North East Victorian Division of General Practice
• Otway Division of General Practice
• West Vic Division of General Practice.

A key strength of LAOS is that the GPs reviewing medical records are working in a similar small rural hospital environment to the doctors and systems being reviewed but are located in a different geographical area. Reviewing GPs are ideally placed to provide an ‘arms length’ review process, which the reference panels then use to issue recommendations about system improvements and educational opportunities within the context of the available resources.

LAOS has resulted in a cultural change; from an attitude of individual blame to one that acknowledges underlying system and process causes for adverse events. LAOS aims to ensure that experience and knowledge is shared throughout the rural medical profession in a non-threatening manner leading to quality improvement in participating rural hospitals.

All LAOS participants feel that there is more confidence in the LAOS program, that there is more ‘closing of the loop’ and that the current recommendations are more sophisticated than those that were made in the early stages of LAOS. We are getting better at what we do; where previously it was GP-initiated involvement, the organisations are now also involved and committed. LAOS has played a substantial role in improving communication between GPs and hospitals.

The LAOS program is confidential and protected by statutory immunity under section 139 of the Health Services Act 1988.

LAOS is a systems approach, not an individual approach.

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Limited Adverse Occurrence Screening (LAOS) program: Annual report 2007-08 (519kb, pdf)

Limited Adverse Occurrence Screening (LAOS) program: Annual report 2006-07 (620kb, pdf)

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