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2005 Limited Adverse Occurrence Screening (LAOS) program review
Page contents: Executive summary | Key findings | Download document
| Updated LAOS Recommendations
Executive summary
The Department of Human Services introduced the Limited Adverse Occurrence
Screening (LAOS) program in 2001 for Victoria’s small rural hospitals. This followed
the development of Victoria’s Clinical Risk Management (CRM) Strategy. The LAOS
program has endeavoured to improve patient safety in small rural hospitals by identifying
preventable adverse events in acute patient episodes of care, and the subsequent
underlying systemic issues, thereby influencing changes in clinical practice and
organisational systems as required. Four years after the implementation of the LAOS
program, the department has undertaken an evaluation of the program to determine
its acceptance and progress by stakeholders.
The objectives of the review are to determine whether the LAOS process leads
to recommendations and actions that improve patient safety in small rural hospitals.
The three key areas of review are:
- evaluation of the implementation of LAOS recommendations in small rural hospitals
- identification of the contribution that the LAOS program makes to the existing clinical risk management (CRM) framework in small rural hospitals
- identification of the benefits of the LAOS program to Victorian small rural hospitals.
Key findings
The following points are key findings from the consultation process:
- The LAOS program is embedded in Victorian small rural hospitals.
- Over 90 per cent of stakeholders interviewed believe that the LAOS program
should continue.
- Clinical risk management varies in its activities across Victoria’s small rural hospitals.
- The LAOS program’s value is stronger in the smaller rural hospitals than in the larger,
more complex rural hospitals.
- The LAOS program can complement the clinical risk management strategies used
in Victorian small rural hospitals.
- The general practitioners participating in the LAOS program have ownership
of the peer review process in the LAOS program and value its contribution to their
clinical practice.
- Recommendations from the LAOS program are used to inform clinical practice
in small rural hospitals.
- There was a lack of a standardised approach to the application of LAOS within
the divisions of general practice.
- There is considerable replication of work across Victoria, with no established
methodology for identifying specific case studies for review.
- There is a need to review the medical records selection criteria (Wolff criteria)
to ensure that it meets the needs of the small rural hospitals.
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 2005 Limited Adverse Occurrence Screening (LAOS) program review - October 2005 (132kb, pdf)
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Updated LAOS Recommendations
Update on recommendations from the 2005 LAOS program review as at April 2007 including new reporting criteria as of 1 July 2009.
| Recommendation |
Detail |
| Recommendation 1 |
That the Department of Human Services enter into a triennial contract with each division of general practice to continue the LAOS program with strict key performance indicators. |
| Recommendation 2 |
That a statewide coordinating role be established through General Practice Division Victoria Ltd (GPDV) to achieve standardisation and consistency in the LAOS program processes and improve efficiency and effectiveness. |
| Recommendation 3 |
That GPDV develops a governance structure for the LAOS program with agreed performance measures, in partnership with the department. |
| Recommendation 4 |
That the current divisions of practice funding be reviewed to enable better utilisation of resources and management of the LAOS program, and enable funding to GPDV to undertake the coordination role, within the current program budget. |
| Recommendation 5 |
That the LAOS program recommendations be developed in a standard format and submitted to the Clinical Risk Management Reference Group (CRMRG) for review and subsequent statewide dissemination. |
| Recommendation 6 |
That GP reviewers receive education which includes:
- A standardised education and training package related to the LAOS program across Victoria.
- Detailed education regarding privacy and statutory immunity legislation.
- Increased education opportunities for LAOS reviewers that are provided locally.
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| Recommendation 7 |
That general practitioners provide a pivotal link between the small rural hospitals and the divisions with the dissemination of the recommendations. |
| Recommendation 8 |
That medical records be de-identified by the project officers before they become a public document. |
| Recommendation 9 |
Modification of the number of records screened – each division to screen two criteria each quarter, and plan advanced screening schedule for a 12-month period. |
| Recommendation 10 |
Following the LAOS review, the trial of the selection criteria has been changed to better reflect the program requirements by the Reference Panels:
- Patient death;
- Unplanned return to theatre within seven days;
- Unplanned re-admission within 28 days;
- Transfer to another health service;
- Patient length of stay greater than 35 days; and
- Any record which has been recommended by a doctor or other health professional for review.
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