care and is not a disciplinary or personnel management mechanism. However,
privileging actions may accompany or cause actions of an administrative or judicial
nature. Each department, service, or clinic will develop criteria for granting clinical
privileges in that department, service, or clinic. In no instance may a person be
assigned or privileged to perform professional duties unless qualified by education,
training, and experience to perform them.
(3) Utilization management. Utilization management evolved from a mandated
requirement for utilization review. Utilization management strives to provide the most
quality patient care possible in the most cost-effective manner. In addition to improving the
quality of medical and dental services delivered, QAP must also ensure access to care
and appropriate allocation of the MTF's resources.
(4) Risk management. Risk management is defined as an organizational
function directed towards preventing accidents and injuries and the lowering of financial
3-10. RISK MANAGEMENT IN HEALTH CARE DELIVERY
a. A risk manager will be designated in writing at each MTF. The risk manager will
be competent in standards, policies, and administration of risk management, basic clinical
disease processes, medical terminology, and accident prevention. The emphasis of risk
management in health care delivery is to minimize avoidable harm to patients, visitors, and
staff. This requires a structured program of problem identification and resolution, staff
sensitization and education, and enhanced patient relations. The principle focus is control
of medicolegal liability. There are two primary areas of interest:
(1) Clinical risk - that risk associated with the delivery of health care. Some
concerns are injury from medical devices, adverse reactions to drugs, or nosocomial
infections. An adverse event occurs when a patient suffers any unintended or the
unexpected negative result during patient care. When an adverse event occurs, person in
charge of the activity where it occurred will ensure that DA Form 4106 (Quality
Assurance/Risk Management Docoument) is prepared and submitted to the head of the
department, service, or clinic within 24 hours of the occurence. If death or life-threatening
injury has occurred, the commander will also be notified. DA Form 4106 will be forwarded
to the risk manager not later than 48 hours of the occurrence.
DA Form 4106 is accessible to authorized persons only.
The completed form will never be placed in an Inpatient Treatment
(c) All adverse events related to the patient's condition and treatment will
be entered on SF 509 (Medical Record - Doctor's Progress Notes).