• All hospital employees
  • Although generally embraced more by nursing staff, all doctors should be aware of the system and capable of putting something into the system

• Any instance where you feel something has happened that should not have:
  • no socomial infections
  • falls
  • medication errors
  • aggression
  • OHS
  • accidents
  • equipment failure
  • errors of clinical decision making
  • near misses: things can go wrong but not cause harm to patients, these are still worth looking into
• NOT for playing politics or complaining about colleagues

• IIMS: incident information management system – is the system used for incident reporting throughout NSW (similar systems are in use in other states)
• IIMS can be accessed from any hospital computer via the intranet
• Link will direct to an electronic form requiring:
  • patient details
  • where it happened
  • what happened
  • suggestions of what could be done better
  • indication of severity – SAC (severity assessment code)
    • SAC-1 (most severe) – usually death or significant disability
    • SAC-2 – patient requires increased level of care (e.g. moved to HDU)
    • SAC-3
    • SAC-4 (least severe)
      • Note: the severity score you give is only an indication – the final severity score may differ

You are NOT required to identify yourself

• Junior doctors are often concerned that if an incident involving themselves is reported that they may be identified and that this may affect their reputation or assessment
• Keep in mind:
  • In most instances senior staff will already be aware of issues even without an IIMS
  • The intent of the system is not to attribute blame but to fix system-related problems
  • Reports ought to be de-identified however this is not necessarily always the case
  • Senior staff may in fact respond positively
    • Contributing to IIMS shows that you are able to reflect on the work you do and are concerned about the quality of care that you / your team / your organisation provides – this is a skill often admired by senior staff
    • This is an opportunity to show how you respond to error and demonstrate self-improvement – this is an impressive skill that often comes up in job interviews

• All SAC-1 are required by policy and law to be investigated with RCA – Root Cause Analysis
  • An investigation organised by the hospital Clinical Governance Unit to identify the ultimate cause and generate recommendations to address this
• Junior doctors may be asked to attend a RCA to provide information but are very rarely the target of the investigation – if you are asked to attend, review the notes and stick to the facts
• RCA team
  • Small group of senior clinicians
  • ~3 meetings over 10 weeks
  • JMOs may be asked to serve on a RCA team where relevant
• Important to relay to the patient and their family that it is a lengthy process as quick answers and solutions are often expected

• Changes in staff training/orientation
• Check lists
• Equipment changes
• Systemic – e.g. ‘between the flags’

• Reflect on the quality of your care
• Get involved in clinical governance