title: One model of healthcare provision lessons learnt through clinical governance.
abstract: OBJECTIVE
  Clinical Governance describes a systematic approach to maintaining and improving the quality of patient care. Risk management includes a themes analysis of clinical incidents and positive interventions with the resulting information disseminated to staff through personal performance plans, and publication and development training workshops. Our model of healthcare provision utilises doctors, nurses and paramedics to assess individuals in custody and this paper discusses the implementation of clinical risk management within this setting.
  
  
  METHODS
  A description of the model of healthcare provision, together with a themes analysis was undertaken for all clinical incidents received by the clinical team. Each incident receives an individual response and is discussed within the clinical risk management committee. From the review of each event, learning outcomes are identified and the information captured on a database. The information is analysed for reoccurring themes and further measures are introduced to ensure a high standard of healthcare provision to all counties.
  
  
  RESULTS
  Of the 86,184 patient/detainee episodes from 11 county forces, from January 2009-December 2009, 159 clinical incidents and positive interventions were generated. These were categorised into Clinical Near Misses--39, Prescribing issues--38, Health and Safety matters--13, Organisational matters--23, Positive Interventions--21 and Professional issues--25.
  
  
  CONCLUSIONS
  Risk management, with a regular review of clinical incidents is an essential part of clinical governance especially when working in a multidisciplinary team providing safe and effective custody healthcare. This analysis contributes to the knowledge base in clinical forensic medicine and supports the importance of identifying educational requirements for staff, working in a multiagency partnership and continuous monitoring of the quality of care for detainees.
authors.affiliation: G4S Forensic Medical Services Limited, Units 6-8 The Bardfield Centre, Great Bardfield, Braintree, Essex CM7 4SL, UK. vanessa.webb1@btinternet.com
authors.forename: Vanessa
authors.initials: V
authors.lastname: Webb
authors.forename: Margaret
authors.initials: M
authors.lastname: Stark
authors.forename: Adam
authors.initials: A
authors.lastname: Cutts
authors.forename: Steve
authors.initials: S
authors.lastname: Tait
authors.forename: Jerry
authors.initials: J
authors.lastname: Randle
authors.forename: Gary
authors.initials: G
authors.lastname: Green
mesh_terms: D054976:Clinical Governance / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004632:Emergency Medical Services; D005550:Foreign Medical Graduates; D006801:Humans; D017146:Models, Organizational; D009726:Nurses; D016134:Organizational Policy; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians; D012308:Risk Management / Q000379:methods; D006113:United Kingdom