quality assurance and quality improvement Flashcards
What are the six key aims for improvement in health care
1) safety - reducing the likelihood of patient harm by medical errors
2) effectiveness - avoiding the underuse and overuse of services and resources
3) patients centeredness – provision of a service that relates to patients and their families accommodating their needs when making decisions
4) timeliness - reduction of waiting times
5) efficiency - reducing waste and cost
6) equity - the closure of racial and income gaps in health
Define quality assurance
The monitoring of the system for detecting emerging problems taking steps to address them and ensuring stability over time QA processess used in EDs include -M&M -complaint auritids -infection control -credentialing -standard setting
Define quality improvement
Is a formal systematic approach to the analysis and efforts to enhance performance. The difference between QA and QI is that
1) QA ensures compliance with standards by means of measurement and inspection with a focus on finding deviation from agreed standards. External driven and relies on monitoring
2) QI offer tools to focus on processess and systems that translate the ideal patient management into care that happens every day. It is often driven internally by clinicians.
QI is different from research in
- aims to improve practice not gain new knowledge
- bias is accepted as long as stable
- adopts current knowledge
- Data collection (not blind, focused on variable studied, just enough to act)
- multiple testing
- chaning hypothesis
List key QI processess
1) multi-disciplinary collaboration
2) patient involvement
3) review of existing processes
4) identification of performance measures
5) implementing a change
6) data collection and analysis
7) communications of outcomes with incorporation of key learning into process redesign education and training.
When gaps are detected between expected and observed performance a QI approach may be undertaken to close the gap. Following successful improvement QA can then be used to moniotr the redesigned process
Define benchmarking and credentialling
Benchmarking - compares performance with others with the use of best practice as a marker for imrpovement
Credenitaling is a formal process to recognize and verify an individuals qualifications to assess their capacity to safely perform a task
Describe the quality cycle
Plan-Do-Study-Act
1) plan - developing a plan to test the change
2) Do - carrying out the test
3) Study - observing and learning from the consequences
4) Act - determining which modifications should be made to the test
It is important that the aims of the QI project are selected and articulated carefully for exampling using the SMART acronym - specific, measurable, attainable, relevant and timely.
List other QI tools
- Process mapping
- Ishikawa diagram - to organise the potential contributing causes of a clinical problem
- Pareto chart is a bar chart of contributory various factors
- Stakeholder analysis - identification of those that are affected by or have influence over the QI projects conclusions
- Run charts
Describe benchmarking and clinical standards
In 2013 National saftey and quality in health service standards (known as the National Standards) became mandatory across all Australian Public Hospital.
in 2017 a second edition with eight standards were published
1) Clinical governance
2) partnering with consumers
3) precenting and controlling health care associated infection
4) medication saftey
5) comprehensive care
6) communicating for saftey standard
7) blood management
8) recognising and responding to acute deteriation
List the domains in the ACEM quality standards
1) Clinical - focuses on the patient care pathway through the ED, from first communications with the ED to admission discharge or transfer and aims a patient centred approach
- Sub point include (triage, initial assessment, diagnosis and investigation, patient management, referral and consolation, reporting, admission and discharge, communications practices, vulnerable and high risk patient)
2) Administration
- Describes the overall management fo tan ED within the whole of hospital context as the interface between acute care and community. It focuses on ensuring that the workforce are suitably trained and supported through the physical environment facilities and resources.
- Subpoints ( environment, facilities and resources, capacity, information and reporting, workforce, organisational culture, emergency management, incident and complaint management, patient saftey)
3) Professional
- Focuses on the professional attributes of the ED team as well as the legal and ethical obligations encountered in the provision of care within the ED
- Subpints ( profressional, leadship, legal and ethical, teamwork and collaboration, public health awareness and advocacy)
4) Education and training domain describes those components of practicing emergency care that are related to ongoing maintenance supericison and development of knowledge skills and profressional attributes.
5) Research
- focuses on the conduct of research within the ED that complies with ethical requirements and good clinical practice guidelines as well as encouraging the collaboration and particpation in research to ensure the ED provide high quality of contemporary and evidence based care
From EM indiex quality standard
- safety –> e.g patient falls
- access - e.g wait times
- acceptability -e.g pt feedback
- effectiveness -e.g time to antibiotics
- efficiency e.g ATS compliance
Describe quality indicators
Can be divided into structure, process and outcome
Structure indicators
-provide information about the organization environment such as human resources, physical resources, physical layout and organizational framework
Process indicators
-measure the provision of care, supplying quantitative data regarding the effectiveness of policies procedures and systems
Outcome indicators
-refer to the result of care and provide quantitative data related to the outcomes of performance, typically including mortality and morbidity and quality of life.
List common quality indicators in the ED
- NEAT
- Time to PCI or thrombolysis
- Time to analgesia
- Time to antibiotics
- waiting time by triage categories
- unplanned re-attendance rates
- Did not wait rates
Broader measures that reflect common ED activities include
- research otuput
- exam pass rates
- patient and staff satisfaction
- staff turnover.
Discuss interventions to change clinical pratice
Consistently effective
- educational outreach visits
- reminders (manual or computerised)
- multi faceted intervetion ( combinations of intervention, audit and feedback, reminders, local consensus)
- Interactive educational meetings
Variably effective
- audit and feedback
- local opinion leaders
- local consensus processs
Little or no effect
- education materials - distribution of guidelines and other general medical information
- didactic educational meeting
- traditional lectures and conferences
