PubMed · 6422380
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D E Brown, J D Levy, M Sarmiento. 1984. Patient-oriented QA activities.. https://pubmed.ncbi.nlm.nih.gov/6422380/
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BACKGROUND: The focus on patient outcomes as performance measures and on processes of care as systems to improve is intensifying. Nevertheless, appropriateness reviews are likely to remain essential (for example, studies evaluating inpatient admission, laboratory testing, invasive procedures, and discharge planning) for several reasons. METHODS: Forbes Regional Hospital (Monroeville, PA) undertook to redesign the process of appropriateness reviews using a computer-assisted methodology. The change was predicated on accessing electronically recorded clinical data collected as part of a state-mandated discharge reporting requirement. RESULTS: More than 90% of diagnosis-related group 182/183 (gastrointestinal/esophagitis) admissions were deemed appropriate on the basis of later manual reviews. This redesign was accomplished at no added expense while the amount of time required to complete the study was decreased. The ability to easily examine relationships identified during the evaluation was also expanded. The experience led to greater enthusiasm on the part of the medical staff to pursue more quality improvement projects. Creation of software programs that can be used repeatedly, modified to change existing thresholds, or expanded to include other conditions was another benefit. Clinicians gained valuable experience and familiarity with information systems. Lastly, all this was accomplished without purchasing new hardware, acquiring updated software, or relying on the presence of an electronic medical record.
This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project.
In 1991 the third of a series of trials of concurrent case note screening was conducted over a 4 month period in one surgical and one medical unit of a busy metropolitan public teaching hospital in South Australia. The conclusion reached was that there is insufficient evidence of consistent improvement to justify the continuation of this expensive method of quality assurance. Traditional monitoring of performance by consultants, perhaps with the aid of computer-assisted management information, should achieve similar results.