quality in healthcare Flashcards
what are the 6 dimensions of quality in healthcare?
-effectiveness - delivering health care that is evidence based
-efficiency
-safety
-patient centered care - takes into account the preferences + aspirations of the individual
-equity / equal for all races gender etc
-accessibility - timely, geographically reasonable etc
how can we ensure quality in health care at a national, organisational and local level?
national level
-clinical audit
-HSE - key performance indicators eg average time of hospital stay
organisation level
-quality reviews
-accreditation eg CORU
local level
-standards/audits
-clinical guidelines
-clinical outcomes
what are the functions of the health information and quality authority?
-setting standards in health and social services eg hygiene standards
-monitoring healthcare quality
-social services inspectorate
-health technology assessment
-providing health info and resources
what is a key performance indicator (KPI)?
measures of performance that are used by organisations to measure how well they are performing against targets or expectations
what is an example of a KPI?
the number of patients that are waiting for more than 6 hours in the emergency department for admission to a hospital bed
what are examples of health performance metrics?
-access- waiting times
-integration - are services patient centered?
-resources - best use of its human and financial resources, use of budgets
what are examples of health performance metrics and targets?
what is accreditation?
means a process involving a measurement of performance of a institution against a set of pre-determined standards
-usually conducted by an authorised body of external agency
-eg educational institutions -schools of physio by ISCP/ CORU
what are standards?
something that is established for use as a rule or basis of comparison in measuring quantity, quality , value etc
-healthcare standards provide rules or minimum requirements for clinical practice
what are the 3 different criteria to meet standards?
-structural criteria
-process criteria
-outcome criteria
what are examples of structural criteria?
-skills
-buildings
-equipment
-staffing ratios
what are examples of process criteria?
-referral pathways
-prescribing patterns
what are examples pf outcome criteria?
-patient satisfaction
-clinical outcomes
what are the CORU standards of proficiency?
-professional autonomy and accountability
-communication, collaborative practice and teamworking
-safety and quality
-professional development
-professional knowledge and skills
define a clinical audit
a clinically led quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and to act to improve care when standards are not met
what does autonomy and accountability mean?
-professioanl autonomy = the ability of professionals to make independent, informed decisions based on their knowledge, skills, and expertise
-Professional accountability is the obligation of individuals to answer for their actions, decisions, and outcomes in their professional roles
what’s the difference between research and audit?
-research generates the knowledge used for the audit, may involve placebo and random allocation and identifies the best form of Rx/ practice
-audit raises questions to be answered by research, no random allocation or placebo, it is an ongoing process and tests whether things are being done the right way
what is the job of the national office of clinical audit?
- to constantly review clinical practice - measure structures, processes & outcomes to make improvements
what are integrated care pathways?
-ICPs define the expected course of events in the care of a patient with a particular condition within a set time scale
-ie a pre-defined plan of patient care relating to a specific diagnosis or operation
what are examples of conditions used in ICPs?
-acute myocardia infarction
-stroke
-DVT
-THR
-TKR
-management of femur fracture
-surgical procedures
what are benefits of care pathways?
-encourages review of current practice
-improves resource utilisation
-builds best practice into everyday care
-improves patient information and encourages involvement
-promotes MDT collaboration
what are the barriers / risks of integrated care pathways?
-ICP may not suit all patient types - must use clinical judgement
-may be seen as prescriptive
-ensuring to update the ICP as new evidence emerges
what are clinical guidelines?
systemically developed standards which assist clinicians and patients in making decisions about appropriate treatment for specific conditions
what are the uses of clinical guidelines?
-reducing inappropriate variation in practice
-as a tool for implementation and evaluating evidence based practice
-a tool for learning
what is NICE?
the national institute clinical excellence - its a organisation in the UK responsible for providing national guidance on promoting good health and preventing and treating ill health
what are examples of topics for NICE guidelines?
-guidelines on:
RA
LBP
stroke
stroke rehab
OA
COPD
respiratory tract infections
what is the difference between a quality standard and a clinical guideline?
-a standard is established for use as a rule or basis of comparison for measuring quantity, quality or value - so eg a healthcare standard provides rules or min requirements for clinical practice
-clinical guidelines are systematically developed statements which assist clinicians and patients in making decisions about appropriate Rx for their condition
what are the uses of an ICP?
-outline roles of MDT
-promote evidence based practice
-improves organisation and efficacy of care
what are the advantages and disadvantages of ICPs?
advantages
- MDT collab
-reduces variation in Rx
-improves patient info
disadvantages
-may not suit all patients
-may not have the time
-may be seen as prescriptive
