International Scientific Conference eRA-6

Economy Session

1. Information Management of School Accidents: An Assessment of SARIS Project

Athanassios Vozikis

University of Piraeus, Economics Dept., Piraeus, Greece

Address for correspondence:

Athanassios Vozikis

Lecturer

University of Piraeus

Department of Economic Science

80, Karaoli & Dimitriou street,

18534 Piraeus , Greece

Tel: +30-210 4142280

Fax: +30-210 4142301

E-mail:

Abstract

Accidental injuries are the leading cause of deaths among children in the western world. Research in various countries indicates that 10 to 25 percent of school-aged children injuries occur in (and around) school environment. However, this reality has not received the attention it deserves in Greece, where the absence of mechanisms for information management of school accidents is more than obvious. The main purpose of our research is to present the analysis and development of a School Accidents Reporting Information System (SARIS) and to evaluate the results of its pilot implementation in Secondary Schools in Greece. Moreover, our scope is to highlight SARIS importance in the achievement of injury prevention and health promotion objectives and to make propositions for its deployment and utilization in the context of public health and safety prevention policies.

Keywords: information management,school accidents, information systems, accident reporting

  1. Introduction

Despite the injury reductions and safety improvements over the last 20 to 30 years injury remains the leading cause of death for children and adolescents in every MemberState in Europe, and more children and adolescents die of injuries than all other causes combined. Of the 55,000 children under 20 years who die each year in the European Union, approximately 21% or a total of 13,000 deaths, are due to unintentional injuries [1], [2].

Injury is the leading cause of death in children and adolescents aged 0-19 years in Greece, as well. In 2005, 287 children and adolescents in this age group died as a result of injury. If the rate of injury death in Greece could be reduced to the level of the Netherlands, one of the safest countries in Europe, it is estimated that 140 or 49% of these lives could have been saved[3].

Recent data from research in various countries indicates that 10 to 25 percent of school-aged children injuries occur in (and around) school environment [4], [5], [6] The research literature indicates that an estimated 10 to 25 percent of all injuries to children and adolescents occur on school property, either unintentionally or through violence [7], with the unintentional injuries to account for more than 90 percent of all injuries occurring at school [8].

School accidents in Greece are estimate to account for about 30 percent of all injuries to school aged children, the highest rate among the 18 countries that participated in the studyof the European Child Safety Alliance, [2]. Yet serious injuries that happen on school grounds and result in hospitalization have not been well studied in Greece.

School accidents have an important social and economic impact on health care costs, lost school time, lost work time for parents, rehabilitation costs and some times deaths [9], [10], [11]. Since injury prevention in a centralized location such as a school may be relatively economical, research into the number and types of injuries occurring in the schools, and during school-related activities, could have practical benefits [12]

  1. School accidents reporting in Greece – Current Situation

Currently, no comprehensive guidelines are available for school administrators and other health and education professionals interested in addressing the problem of injuries in the school environment. Thus, schools need to begin by assessing the causes of injuries within individual schools in order to target the leading causes of injury and to prevent them.

The educational and health community has long recognized that reporting of school accidents is incomplete, which greatly hampers successful public prevention interventions. Various researches estimate that only about 10% of the school accidents are actually recorded in the daily school calendar [13], [14]. The current paper-based system is also slow and the information often in a form that exceeds the point of optimal use, thus significantly reducing its value. The current reporting system is very labor intensive and often requires multiple steps of data entry [15]. This has a result many schools to under-report accidents [16]. Most relevant research in the medical and public health literature [17] focuses on the underreporting of school injuries and the poor quality of data collected, rather than possible prevention measures.

Studies undertaken in accident and emergency (A&E) departments [18], or in secondary schools in Greece [13] have provided some information on the spectrum of school injuries, but research findings never fed back to the authorities or to the relevant schools. The potential for using accident data to improve the school safety is complicated, by the number of agencies involved and remains unrealized in Greece. Patterns and causes of school injuries are poorly understood, and resources to help public health and education professionals address injuries are scarce. Schools usually respond to injuries on an ad hoc basis -after the damage is done [19]. Injury events are not consistently tracked, and it is often difficult to identify who has responsibility for preventing a recurrence [20].

  1. Research Scope and Methodology

The primary goals of the pilot implementation of the School Accidents Reporting Information System (SARIS) is to develop a production-capable information system, which if successful could be rolled out nationwide, and to create an initial architecture that could be leveraged across other reporting systems in the educational or health care sector.Moreover, our scope is to highlight SARIS importance in the achievement of injury prevention and health promotion objectives and to make propositions for its deployment and utilization in the context of public health and safety prevention policies.

  1. The SARIS Architecture

The current design and implementation SARIS , is based on the Greek Schools' Network (GSN) that focuses in providing useful services to all members of the primary and secondary education community. The SARIS pilot developed a Web site portal as one of its home page options. This first step created the initial Web architecture and allowed the exploration of Web technology for GSN services in a very low-risk way. Below is a diagram showing the elements of the common architecture and information flows of SARIS (Figure 1):

SARISDatabase, records andmanages a wide rageofcontinuously renewing operationaldata. DataWarehousesarecapableofanalyticaldata selection from relational databases, and furthermore data “cleaning” and integrating.

Agraphicalpresentationofinformationmanagement in SARISisshowninFigure 2:

  1. SARIS Pilot Implementation results

The pilot demonstrated an acceptable and well-received Internet approach for providing GSN services, the architecture was designed to easily extend to additional applications and to scale smoothly to accommodate increased numbers of users. We found the selected architecture compatible with GSN existing computing infrastructure. Additionally, the selected architecture fitted in with GSN longer-term Internet strategies, including compliance with National E-Government strategies.

The success of the SARIS pilot implementation depends heavily on identifying the social welfare earned for each entity involved. Participating entities believe that they succeeded a synergistic relationship across all levels -National level, school level, health care unit level and students. Consequently, the social welfare is not specifically identified with a particular report level, but provides benefit at all crucial parameters, as Reporting of school accidents data was identified as a strategic goal for both educational and health care sectors, Data accuracy and quality, Number of school accidents cases reported, Web-based system based on mainstream technology, etc.

  1. Discussion - Proposals for students’ injury prevention and health promotion policies

Schools are assuming to play an increasingly important role in health promotion, disease prevention and injury prevention. Public health professionals are important partners for educators and other school personnel, bringing expertise and resources that can strengthen efforts to prevent injuries and violence in schools [21].

As the SARIS pilot was considered successful from technical and functional aspect, supplementary interventions must be implemented, along with SARIS full productive operation in a nationwide deployment. These interventions should promote and strengthen public policies in health and injury prevention.

Finally, findings should be disseminated broadly (officials, staff, students and communities) for developing and evaluating interventions, with school administration, education and health officials, students, and families in community-wide injury and violence prevention efforts.

References

  1. European Child Safety Alliance (ECSA), , Priorities for Child Safety in the European Union: Agenda for Action, Amsterdam, The Netherlands, 2001
  2. European Child Safety Alliance (ECSA), Eurosafe, “Child Safety Summary Report Card for 18 Countries”, Amsterdam, The Netherlands, 2007
  3. European Child Safety Alliance (ECSA), Eurosafe, “Child Safety Report Card for Greece”, Amsterdam, 2009
  4. NationalCenter for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, The CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000-2006,AtlantaGA, 2008
  5. World Health Organization (WHO), World report on child injury prevention, Geneva, 2008
  6. Children’s Safety Network Injuries in the School Environment: A Resource Guide (Second Edition), Newton, MA: Education Development Center, Inc., 1997
  7. U.S. Congress, Office of Technology Assessment. Risks to Students in School. Washington DC:U.S. Government Printing Office, 1995
  8. Posner, M.. Preventing school injuries: A comprehensive guide for school administrators, teachers, and staff. New Brunswick, NJ: Rutgers University Press, 2000
  9. European Commission (E.C.), “Burden of Fatal Injuries in the European Union”, Report of the Task Force on Burden of Injuries, Working Party on Injuries and AccidentsEuropean Commission / Health and Consumer Protection (DG Sanco), Athens, 2005
  10. Polinder S., Meerdin W.J., Mulder S., Petridou E., Beecka Ed van & EUROCOST Reference Group, Assessing the burden of injury in six European countries, Bulletin of the World Health Organization 2007;85:27-34.
  11. Institute of Medicine (Committee on Injury Prevention and Control, Division of Health Promotion and Disease Prevention), Reducing the Burden of Injury: Advancing Prevention and Treatment. Bonnie RJ, Fulco CE, and Liverman CT (eds). NationalAcademy Press: Washington, DC., 1999
  12. Vorko A., Jovic F., Multiple attribute entropy classification of school-age injuries, Accident Analysis and Prevention 32, 2000, 445-454
  13. Georgiakodis F., Vozikis A., The epidemiology of school accidents in Greece: Research findings from Secondary schools, Proceedings of the 17th Greek Statistical Conference, 2004, p. 83-92
  14. Center for Research and Prevention of Injuries (CEREPRI) European Home and Leisure Accident Surveillance, Annual EHLASS Report: Greece 2002, 2003
  15. National Research Council and Institute of Medicine.. Challenges in Adolescent Health Care: Workshop Report. Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press., 2007
  16. Stark C, Wright J, Shiroyama C, LeeJ.School injuries in the west of Scotland: estimate of incidence and health service costs. Health Bulletin, 1997, 55:44-8.
  17. Latif AHA, Williams WR, Sibert J., Primary school accident reporting in one education authority. Arch Dis Child, 2002;86:91-4.
  18. Center for Research and Prevention of Injuries (CEREPRI) Ιnjury Statistics Portal 2005
  19. Towner EML, Jarvis S N, Walsh S S M, Aynsley-Green A. Measuring exposure to injury risk in schoolchildren aged 11-14, BMJ 1994;308:449-52
  20. Petridou E.,. From injury research to injury prevention: facilitating the connection, Injury Control and Safety Promotion, 2003, Vol. 10, No. 3, pp.
  21. Center for Disease Control and Prevention (CDC) Division of Adolescent and School Health (DASH), School Health Guidelines to Prevent Unintentional Injuries and Violence, Morbidity and Mortality Weekly Report, December 7, 2001 / 50(RR22);1-46

2. The Landscape of Medical ErrorsReporting Systems Worldwide

Yannis Pollalis

Associate Professor

University of Piraeus

Department of Economic Science

80, Karaoli & Dimitriou street,

18534 Piraeus , Greece

Tel: 210 4142353

E-mail:

Athanassios Vozikis

Lecturer

University of Piraeus

Department of Economic Science

80, Karaoli & Dimitriou street,

18534 Piraeus , Greece

Tel: 210 4142280

E-mail:

Marina Riga

Phd Candidate

University of Piraeus

Department of Economic Science

80, Karaoli & Dimitriou street,

18534 Piraeus , Greece

Tel: 210 4142353

E-mail:

Abstract

Formanyyears, medicalerrors have been averyfrequentphenomenon in the Health Care Systemsandoneofthemostimportantcausesof mortality and morbidity, universally. Medical errors are on the increase both in Europe and in the United States of America which have forced them to confront the problem and take measures. Much has been written about the improvements in reporting systems in order to identify, collect, analyse and report medical errors and patient adverse events, for enhancing patient safety and health care quality. The aim of this paper is to present the current situation regarding the medical error reporting information systems, worldwide. For example, the Netherlands is the latest country to announce the developmentof a national medical error reporting system, Australia hashad one since 1989, Denmark has one, the UK introduced theirsin 2001, Canada announced their plans in 2003 and the USA hasa proliferation of error reporting systems. Moreover, developed western countries do thereforeseem to have "bought into" the message that medical error reportingsystems are a very crucial issue. Thus, this paper presents the effectiveness of medical error reporting systems for the stakeholders in the health sector. Of course, the key task for the future effectiveness of any medical errors’ reduction strategy will be to identify quality assurance practices that could respond effectively to system data.

Keywords: Medical errors, adverse events, information reporting systems

  1. Introduction

There is a substantial amount of public concern about patient safety, as, according to estimates from major studies, hundreds of thousands die in hospitals each year all over the developed world as a result of medical errors that could have been prevented. Unprecedented research commissioned by the EU has found that almost one out of every four families has experienced a serious medical error.

Proposals range from the implementation of nationwide mandatory reporting with public release of performance data to voluntary reporting and quality-assurance efforts that protect the confidentiality of error-related data. Any successful safety program will first require a national effort to make significant investments in information systems, along with providing an environment and education that enables to contribute to an active quality improvement process.

In Greece, an increasing number of patients are worried about the possibility of suffering a medical error but the organisations they can turn to are just few and with limited intervention power.

The creation of a specialized public organisation, for the management of medical errors nationwide, as well as the implementation of relative hospitals monitoring systems, is paramount in order to achieve control of the problem. Theaimofthepresent study istopresent the current situation regarding the medical error reporting information systems, worldwide.

In detailed, in chapters 2 and 3, the definitions, classifications and epidemiology and root causes of adverse events and medical errors are given.

In chapter 4 the landscape of medical errors reporting systems worldwide is presented and in chapter 5, the research agenda on adverse events and medical errors reporting systems is described. Finally, in chapter 6, conclusions are drawn.

2. Definitions, Context and Classifications

2.1 Definitions and Context

The World Health Organization (WHO) Collaborating Centers for International Drug Monitoring defines an adverse drug event as follows (WHO, 1984):

  • “Noxious and unintended and occurs at doses used in man for prophylaxis, diagnosis, therapy, or modification of physiologic functions.”

In To Err is Human, the IOM (1999) adopted the following definitions:

  • An error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.
  • An adverse event is defined as an injury caused by medical management rather than by the underlying disease or condition of the patient

In an effort to thoroughly consider all of the relevant issues related to medical errors, the QuIC expanded of the IOM definition, as follows (QuIC, 2000):

  • An error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Errors can include problems in practice, products, procedures, and systems.

2.2 Classifications

There are many types of medical errors. The following seven categories summarize types of medical errors that can occur:

  • Medication Errors, such as a patient receiving the wrong drug
  • Surgical Error, such as amputating the wrong limb.
  • Diagnostic error, such as misdiagnosis leading to an incorrect choice of therapy, failure to use an indicated diagnostic test, misinterpretation of test results, and failure to act on abnormal results.
  • Equipment failure, such as defibrillators with dead batteries or intravenous pumps whose valves are easily dislodged or bumped, causing increased doses of medication over too short a period.
  • Infections, such as nosocomial and post-surgical wound infections.
  • Blood transfusion-related injuries, such as a patient receiving an incorrect blood type.
  • Misinterpretation of other medical orders, such as failing to give a patient a salt-free meal, as ordered by a physician.

There are many possible ways to categorize medical errors, but no universally accepted taxonomy. Various proposed classifications have included (Thomas et al., 2000), (Bates et al, 1995), (Dickinson, 2000), (Null et al, 2007), (Lazarou, Pomeranz & Corey, 1998) :

  • Type of health care service provided (e.g., classification of medication errors by the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP, 1998)).
  • Severity of the resulting injury (e.g., sentinel events, defined as “any unexpected occurrence involving death or serious physical or psychological injury” by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 2006).
  • Legal definition (e.g., errors resulting from negligence (IOM, 1999)).
  • Type of individual involved (e.g., physician, nurse, patient).

Leap, proposed a classification of medical errors’ types as presented in the Table 1 (Leap, 1993):