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Méthodologie et outils avancés SISPIA pour le développement de cartographies corrélatives des risques ; de l'aéronautique vers d'autres secteurs d'activité

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Méthodologie et outils avancés SISPIA pour le développement de cartographies corrélatives des risques ; de l'aéronautique vers d'autres secteurs d'activité
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... La méthode Orion ® est fondée sur l'expérience de l'aéronautique qui a été un précurseur dans la gestion des risques, tant l'accident d'avion est perç u comme inacceptable, bien que la mortalité liée à ces accidents soit très inférieure à la mortalité liée aux erreurs médicales à l'hôpital [4,5]. ...
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Purpose: Morbimortality review is now recommended by the French Health Authority (Haute Autorité de santé [HAS]) in all hospital settings. It could be completed by Comités de retour d'expérience (CREX), making systemic analysis of event precursors which may potentially result in medical damage. As commonly captured by their current practice, medical teams may not favour systemic analysis of events occurring in their setting. They require an easy-to-use method, more or less intuitive and easy-to-learn. It is the reason why ORION(®) has been set up. Methods: ORION(®) is based on experience acquired in aeronautics which is the main precursor in risk management since aircraft crashes are considered as unacceptable even though the mortality from aircraft crashes is extremely low compared to the mortality from medical errors in hospital settings. The systemic analysis is divided in six steps: (i) collecting data, (ii) rebuilding the chronology of facts, (iii) identifying the gaps, (iv) identifying contributing and influential factors, (v) proposing actions to put in place, (vi) writing the analysis report. When identifying contributing and influential factors, four kinds of factors favouring the event are considered: technical domain, working environment, organisation and procedures, human factors. Although they are essentials, human factors are not always considered correctly. The systemic analysis is done by a pilot, chosen among people trained to use the method, querying information from all categories of people acting in the setting. Results: ORION(®) is now used in more than 400 French hospital settings for systemic analysis of either morbimortality cases or event precursors. It is used, in particular, in 145 radiotherapy centres for supporting CREX. Conclusion: As very simple to use and quasi-intuitive, ORION(®) is an asset to reach the objectives defined by HAS: to set up effective morbi-mortality reviews (RMM) and CREX for improving the quality of care in hospital settings. By helping the efforts of medical teams, ORION(®) is an essential tool contributing to the patients' security.
Article
Large modifications are on going in our medical practice in oncology (cancer incidence, ageing, rules, authorizations, billings…). To obtain the best results as possible implies a quality control of the equipments (drugs, machines…), of the professionals (certification) and of the organisations (accreditations). Radiation oncology plays a key role in the multidisciplinary treatment of cancer ant is very sensitive to quality assurances due to its specificities: different tumours, various patients, multiple sequences of treatment with high tech machines and information systems. From 2003, a progress policy has been developed with the MeaH (Mission d'évaluation et d'audit hospitalier). Rapidly, the transfer of security policies from industry to medicine has been considered. This paper will present the first results and their potential implications in the field of oncology.
Article
After working on treatment organization in radiotherapy (bonnes pratiques organisationnelles en radiothérapie--action pilote MeaH 2003), the development of a security policy has become crucial. With the help of Air France consulting and the MeaH, three cancer centers in Angers, Lille et Villejuif worked together on the implantation of experience feed back committees (Crex) dedicated to the registration, analysis and correction of precursor events. This action has now been implemented in all the FNCLCC centers. It seems now important to have a program of mutualisation of corrective actions for all participants. This will allow to review the Orion method of events analysis.
Article
After working on treatment organisation in radiotherapy (bonne pratiques organisationnelles en radiothérapie - action pilote MEAH 2003), the development of a security policy has become crucial. With the help of Air France Consulting and the MEAH, three cancer centers in Angers, Lille and Villejuif worked together on the implantation of experience feed back committees (CREx) dedicated to the registration, analysis and correction of precursor events. After two years, we report the centre Oscar-Lambret experience in Lille and try to get the recommendations for generalisation of the process. This seems now to be compulsory for security management in oncology.
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