Introduction

In recent years, repid advances are made in medical science with new innovation. Appearing of new health problems, high expectation of health consumers, escalating costs of health care providers to render accountability for the quantity and quality, timeliness and cost of health services are rendered. Increased discussions about the validity of health services offered by the institution in the press and the court of law and with potential to abuse new diagnostic and therapeutic modalities have necessitated introduction of quality assurance program in the hospital.

What is quality assurance?

Definition of quality assurance: richaed thompson defines quality as the optional achievable result of each patient. the avoidance of physician induced complication and the attention to patient and family needs in manner that, both cost effective and reasonably documented.

Assurance of quality begins with an enquiry into or surveillance of three aspects of the care being given: (1) The structure within which the care is given (hospital), (2) the process of providing the care (providers of care) and (3) the outcome (the end result of care). The term quality assurance includes several components among them utilization review, medical care evaluation, risk management and peer review. The objectives of risk management plan are to provide safe environment for its patients. Implementation of corrective action to reduce identified risk and prevents future exposures through appropriate individuals or through designed mechanisms.

What is quality assurance program?

The quality assurance program is a comprehensive and coordinated network of formal mechanisms that provide ongoing objective assessment of patient care services and correction of identified problems.

Historical perspective

In the 1860s for example, Florence nightingale helped to lay the foundation for quality assurance programs by advocating a uniform system for collecting and evaluation hospital statistics. In 1908 EW Groves, MD, a British surgical proposed a registry for all outcomes of surgical proposed. In 1910 Dr. Abraham Flexner reported the poor quality of medical education which resulted in closing of 60 of 155 US medical school by 1920. In 1916 Dr Earnest codman of boston enthusiastically emphasized the fact that the professional efficiency of the hospital could not be properly evaluated without good medical records and the study of end results. george gray ward, probably inaugurated the first real medical audit in 1918 at women’s hospital, New York City. Then in 1929 thomas R Panton presented a plan for professional service accounting and medical audit.

The joint commission on accreditation of hospitals (JCAH) was established in 1952. In 1955, JCAH began to stress the concept of medical audits, since then JCAH is playing a very important role in updating standards and contributing significantly for quality assurance program.

Quality assurance program

The assurance of quality implies a commitment beyond simply measurement and evaluation. It implies a commitment to take corrective action if the care rendered does not meet the criteria of quality. A good quality assurance program is imperative to the hospital organization. The process investigates three aspect of care, namely, the framework within which care provided. the term quality assurance, which is a broad team that encompasses several components, i.e. utilization review, medical care evaluation, risk management and peer review.

The hospital shall conduct an ongoing hospital wide quality assurance program to continuously monitor and evaluate the quality of care. The purpose of this program is to identify variations from accepted standards of care, to identify trends or patterns suggesting problems, and to indicate options for corrective actions. The goal is to achieve the highest standards of patient care that can be delivered with available resources.

The hospital shall have a written quality assurance plan, approved by the medical staff, administration, and governing body, that includes authority, accountability, lines of communication, to process systematically the monitoring and evaluating of the quality of patient care.

There shall be an ongoing evaluation of patient care services to overcome and identify problems and to improve clinical performance through integrated quality assurance activities by participation of physicians and other health care professionals.

The program shall develop written criteria by the concerned staff which shall related to structure, process, and outcome, specific to departments and the hospital, to identify the deviations, if any, and to implement actions though various methods, e.g. education, revised policies, equipment, personnel, amended privileges, etc.

Evidence of periodic monitoring with adequate samples in all aspects of services consistent with prescheduled and predetermined programs is carried out to achieve the objective yet maintain confidentiality.

Responsibility

It is the responsibility of the governing body and ministry of health through the hospital administration, medical staff, and others to provide the best possible health care within available resources at par with the developed criteria with ongoing monitoring and readjusting of the services and facilities.

Reporting

The channel of reporting for all quality assurance activities shall be clearly written by drawing an organization chart with classifications of units and department communicated to all concerned. The report originates from units or departments with findings, and suggested actions taken, or to be taken. Reporting includes pertinent findings with solutions relating to departments and services, medical staff, administration, or governing body, to higher authorities or committees for timely suggestions and approval for implementation.

Reporting is of two types, routine as per schedule, and special when an issue requires urgent solution to solve the problem. The medical staff functions are performed by monitoring and evaluation of the quality and appropriateness of patient care and the clinical performance of all individuals with clinical privileges, through monthly meeting of clinical departments or major clinical services including, surgical care review, drug usage evaluation, medical record review functions, blood usage review, pharmacy, and therapeutic functions.

Participation

The monitoring and evaluation of the quality and appropriateness of patient services in coordination with the predetermined entries shall cover all aspects of care provided by the hospital and its departments, and services with no exception shall participate in the above activities and hospital wide functions performed, e.g. infection control, utilization review, variance review, basic management, safety, and patient satisfaction.

The following medical staff functions shall be reviewed:

1. Blood usage review
2. Drug usage review
3. Pharmacy and therapeutic review
4. Medical record review
5. Peer review (on going)
6. Surgical and invasive procedure case review

Data sources

The following are used as data sources, to identify and verify potential problems, and may include at a minimum:

1. Medical records
2. Morbidity and mortality review
3. Monitoring and evaluation
4. Finding from committee activities
5. Review of prescriptions and drug profiles
6. Occurrence variance reports
7. Review of diagnostic clinical reports
8. Utilization review finding
9. Patient satisfaction surveys
10. Patient satisfaction finding
11. Patient complaints
12. Staff interviews and observations
13. Staffing plan
14. Policies and procedures.

Quality assurance process

The hospital shall have a planned, systematic, and ongoing comprehensive monitoring and evaluation process, based on indications of pre developed criteria to identify any deviation or problems to resolve appropriately with the concerned services, departments or individuals to improve performance. These activities shall be documented and records maintained for a minimum period of five years.