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Wednesday, 25 April 2018

Circular details

Title: Annual (2008) Edition of From Death We Learn
Document ID: Information Circular IC 0043/09
Date of issue: Thursday, 22 January 2009
Status: NO LONGER APPLICABLE
File number(s): 06-02788
Description: Annual editions of From Death We Learn highlight key lessons learned from investigations and or a review of deaths including coronial investigations and inquests. The production is used to raise awareness of these issues, and as a means to educate health professionals about the lessons learned from unexpected or preventable deaths.
Category: Clinical
Period of effect: from 1 December 2008
Review date: 3 December 2012
Authorised by: Dr Robyn Lawrence, EXECUTIVE DIRECTOR, Innovations and Health Services Reform, 04-Dec-2008
Acrobat version:
Download this circular in Adobe Acrobat format.   Information Circular - IC 0043/09  [29KB]
Print version: View print version View print version

Attachments:

this attachment in Adobe Acrobat format   From Death We Learn  [361KB]
Related websites:
Internet Link   Office of Safety and Quality in Healthcare  ::  Policies and publications

Annual (2008) Edition of From Death We Learn

The purpose of this Information Circular is to promote and circulate information about the 2008 edition of From Death We Learn.  The 2008 edition was written and prepared by the Coronial Liaison Unit (CLU) in the Office of Safety and Quality in Healthcare.

Background

The health system endeavours to minimise the occurrence of adverse events and to optimise patient safety.  Investigations of unexpected or preventable deaths that have progressed to coronial investigation provide valuable insight into the way the health system works.  Results of coronial inquests are shared amongst health professionals to raise awareness and as a means to educate health professionals about the lessons learned from unexpected and preventable deaths.

The process

Each year, the CLU produces a series of vignettes in the form of a single booklet that highlight unusual and/or significant outcomes from coronial inquiries and other investigations following death.  Production of From Death We Learn is a means of disseminating this important information to health professionals, health services and the general community.

The production serves to assure all stakeholders, especially the public, that unexplained and/or unexpected deaths are given serious consideration by the Department of Health, and that the recommendations arising from inquests are implemented as a means to prevent similar occurrences.

The publication is distributed to a wide range of health and allied health professionals across the state.


Dr Robyn Lawrence
EXECUTIVE DIRECTOR
INNOVATIONS AND HEALTH SERVICES REFORM

This circular last updated: Thursday, 22 January 2009 at 11:31am

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