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Accreditation
Terms modified by Accreditation Selected AbstractsREPRODUCTIVE TOURISM IN ARGENTINA: CLINIC ACCREDITATION AND ITS IMPLICATIONS FOR CONSUMERS, HEALTH PROFESSIONALS AND POLICY MAKERSDEVELOPING WORLD BIOETHICS, Issue 2 2010ELISE SMITH ABSTRACT A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to more recent ,players' in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices. [source] The Creation of Emergency Health Care Standards for Catastrophic EventsACADEMIC EMERGENCY MEDICINE, Issue 11 2006Robert A. Wise MD The creation of health care standards by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in a defined area with known events follows a predictable process. A problem area (e.g., hand hygiene) is identified from multiple sources. The JCAHO then calls together experts from around the country, and through debate and the comparison of positions of various people within the health care arena, a new standard informed by these views can be developed. Once developed, it is vetted and becomes established as a Joint Commission standard. But what happens when an event has never happened, cannot be reliably predicted, and, one hopes, will never come to pass? How can one create any meaningful standards? This is the situation when considering a number of scenarios related to disasters and mass casualty events. [source] Standardized Cytopathology Training through Accreditation in the United StatesCYTOPATHOLOGY, Issue 3 2010R. Tambouret No abstract is available for this article. [source] The BSCC Code of Practice , exfoliative cytopathology (excluding gynaecological cytopathology)CYTOPATHOLOGY, Issue 4 2009A. Chandra Exfoliative cytopathology (often referred to as non-gynaecological cytology) is an important part of the workload of all diagnostic pathology departments. It clearly has a role in the diagnosis of neoplastic disease but its role in establishing non-neoplastic diagnoses should also be recognised. Ancillary tests may be required to establish a definitive diagnosis. Clinical and scientific teamwork is essential to establish an effective cytology service and staffing levels should be sufficient to support preparation, prescreening, on-site adequacy assessment and reporting of samples as appropriate. Routine clinical audit and histology/cytology correlation should be in place as quality control of a cytology service. Cytology staff should be involved in multidisciplinary meetings and appropriate professional networks. Laboratories should have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd. Consultant pathologists should sign out the majority of exfoliative cytology cases. Where specimens are reported by experienced biomedical scientists (BMS), referred to as cytotechnologists outside the UK, this must only be when adequate training has been given and be defined in agreed written local protocols. An educational basis for formalising the role of the BMS in exfoliative cytopathology is provided by the Diploma of Expert Practice in Non-gynaecological Cytology offered by the Institute of Biomedical Science (IBMS). The reliability of cytological diagnoses is dependent on the quality of the specimen provided and the quality of the preparations produced. The laboratory should provide feedback and written guidance on specimen procurement. Specimen processing should be by appropriately trained, competent staff with appropriate quality control. Microscopic examination of preparations by BMS should be encouraged wherever possible. Specific guidance is provided on the clinical role, specimen procurement, preparation and suitable staining techniques for urine, sputum, semen, serous cavity effusion, cerebrospinal fluid, synovial fluid, cyst aspirates, endoscopic specimens, and skin and mucosal scrapes. [source] Similar Deficiencies in Procedural Dermatology and Dermatopathology Fellow Evaluation despite Different Periods of ACGME Accreditation: Results of a National SurveyDERMATOLOGIC SURGERY, Issue 7 2008SCOTT R. FREEMAN MD BACKGROUND Fellow evaluation is required by the Accreditation Council for Graduate Medical Education (ACGME). Procedural dermatology fellowship accreditation by the ACGME began in 2003 while dermatopathology accreditation began in 1976. OBJECTIVE The objective was to compare fellow evaluation rigor between ACGME-accredited procedural dermatology and dermatopathology fellowships. METHODS Questionnaires were mailed to fellowship directors of the ACGME-accredited (2006,2007) procedural dermatology and dermatopathology fellowship programs. Information was collected regarding evaluation form development, delivery, and collection. RESULTS The response rates were 74% (25/34) and 53% (24/45) for procedural and dermatopathology fellowship programs, respectively. Sixteen percent (4/25) of procedural dermatology and 25% (6/24) of dermatopathology programs do not evaluate fellows. Fifty percent or less of program (4/8 procedural dermatology and 3/7 dermatopathology) evaluation forms address all six core competencies required by the ACGME. CONCLUSION Procedural fellowships are evaluating fellows as rigorously as the more established dermatopathology fellowships. Both show room for improvement because one in five programs reported not evaluating fellows and roughly half of the evaluation forms provided do not address the six ACGME core competencies. [source] Adverse Event Reporting: Lessons Learned from 4 Years of Florida Office DataDERMATOLOGIC SURGERY, Issue 9 2005Brett Coldiron MD, FACP Background Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting. Purpose To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004. Methods We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches. Results Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer. Conclusions Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths. [source] Limited Opportunities for Paramedic Student Endotracheal Intubation Training in the Operating RoomACADEMIC EMERGENCY MEDICINE, Issue 10 2006Bradford D. Johnston MD Abstract Background Paramedics, who often are the first to provide emergency care to critically ill patients, must be proficient in endotracheal intubation (ETI). Training in the controlled operating room (OR) setting is a common method for learning basic ETI technique. Objectives To determine the quantity and nature of OR ETI training currently provided to paramedic students. Methods The authors surveyed directors of paramedic training programs accredited by the Commission on Accreditation of Allied Health Education Programs. An anonymous 12-question, structured, closed-response survey instrument was used that requested information regarding the duration and nature of OR training provided to paramedic students. The results were analyzed by using descriptive statistics. Results From 192 programs, 161 completed surveys were received (response rate, 85%). OR training was used at 156 programs (97%) but generally was limited (median, 17,32 hours per student). Half of the programs provided fewer than 16 OR hours per student. Students attempted a limited number of OR ETI (median, 6,10 ETI). Most respondents (61%) reported competition from other health care students for OR ETI. Other identified hindering factors included the increasing OR use of laryngeal mask airways and physicians' medicolegal concerns. Respondents from 52 (33%) programs reported a recent reduction in OR access, and 56 (36%) programs expected future OR opportunities to decrease. Conclusions Despite its key role in airway management education, the quantity and nature of OR ETI training that is available to paramedic students is limited in comparison to that available to other ETI providers. [source] Profiles in Patient Safety: Antibiotic Timing in Pneumonia and Pay-for-performanceACADEMIC EMERGENCY MEDICINE, Issue 7 2006Jesse M. Pines MD The delivery of antibiotics within four hours of hospital arrival for patients who are admitted with pneumonia, as mandated by the Joint Commission for the Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services, has gained considerable attention recently because of the plan to implement pay-for-performance for adherence to this standard. Although early antibiotic administration has been associated with improved survival for patients with pneumonia in two large retrospective studies, the effect on actual patient care and outcomes for patients with pneumonia and other emergency department patients of providing financial incentives and disincentives to hospitals for performance on this measure currently is unknown. This article provides an in-depth case-based description of the evidence behind antibiotic timing in pneumonia, discusses potential program effects, and analyzes how the practical implementation of pay-for-performance for pneumonia conforms to American Medical Association guidelines on pay-for-performance. [source] Comparison of dental licensure, specialization and continuing education in five countriesEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2002Titus Schleyer Dental practice and education are becoming more globalized. Greater practitioner and patient mobility, the free flow of information, increasingly global standards of care and new legal and economic frameworks (such as European Union [EU] legislation) are forcing a review of dental licensure, specialization and continuing education systems. The objective of this study was to compare these systems in Canada, France, Germany, the UK and the US. Representatives from the five countries completed a 29-item questionnaire, and the information was collated and summarized qualitatively. Statutory bodies are responsible for licensing and re-licensing in all countries. In the two North American countries, this responsibility rests with individual states, and in Europe, with the countries themselves, mainly governed by the legal framework of the EU. In some countries, re-licensure requires completion of continuing education credits. Approaches to dental specialization tend to differ widely with regard to definition of specialities, course and duration of training, training facilities, and accreditation of training programmes. In most countries, continuing education is provided by a number of different entities, such as universities, dental associations, companies, institutes and private individuals. Accreditation and recognition of continuing education is primarily process-driven, not outcome-orientated. Working towards a global infrastructure for dental licensing, specialization and continuing education depends on a thorough understanding of the international commonalities and differences identified in this article. [source] Negotiating Assimilation: Chicago Catholic High Schools' Pursuit of Accreditation in the Early Twentieth CenturyHISTORY OF EDUCATION QUARTERLY, Issue 3 2006Ann Marie Ryan [source] Systems for accreditation in blood transfusion servicesISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2009S. Hindawi Accreditation is a non-governmental, voluntary process that evaluates institutions, agencies, and educational programs. It is defined as the process whereby an agency or association grants public recognition to Institutes or Blood Banks for having met certain established standards as determined through initial and periodic evaluations that usually involve submitting a self-evaluation report, site inspection by a team of experts, and evaluation by an independent board or commission. To be accredited Institution and or Blood Transfusion Services should establish and maintain quality systems involving all activities that determine the quality policy objectives & responsibilities taking into account the principles of good manufacturing practice (GMP). There are many Established systems for accreditation which can help any institution to know its strengths, weaknesses and opportunities through an informed review process. Any assessment and subsequent accreditation is made with reference to a set of standards so that the standing of an institution can be compared with that of other similar institutions. In summery the accreditation is a continuous process for improvement of quality and safety of participating institutes or facilities and we should encourage all health institutes to be involved in one or another system for accreditation. There is a need for a local or regional accreditation system for health institutes especially for blood transfusion services to help in the development and improvement of the quality of their services. [source] Risk management of extravasation of cytostatic drugs at the Adult Chemotherapy Outpatient Clinic of a university hospitalJOURNAL OF CLINICAL NURSING, Issue 7 2005Nilce Piva Adami PhD Aims and objectives., To verify the incidence of extravasation of cytostatic drugs in patients treated on an outpatient basis at a university hospital in the city of São Paulo, Brazil, during the period from 1998 to 2002, and to assess the quality of care provided by the nursing team using a protocol adopted for the treatment of this adverse event as a parameter. Background., The movement for quality in healthcare services has been a recent event in Brazil, mainly as the result of the Brazilian Program of Hospital Accreditation instituted in 1998. Considering the emphasis on risk management, it is important to mention the monitoring of the occurrence of extravasations of cytostatic drugs in order to improve the quality of nursing care provided to cancer patients. Design and methods., An evaluative study with a descriptive, prospective and longitudinal design was conducted, based on the documentary analysis of the notification of 216 extravasations of vesicant and irritant drugs that occurred between 1998 and 2002 and the corresponding prescriptions of cold or hot compresses. Results., The mean incidence of extravasations ranged from 0·2 to 1·4% over the five years of the study. Incorrect prescription of the type of compress was observed for three patients. Undesired effects were ulcers caused by the extravasation of vinblastine and dacarbazine in two cases. Conclusions., The low incidence of both extravasation and tissue damage demonstrates the adequate quality of nursing care provided to cancer patients at the outpatient clinic studied. However, the identification of the lack of 12 records of thermal treatment and of three erroneous prescriptions requires the implementation of educational measures to prevent these types of incident. Relevance to clinical practice., The relevance of this study to clinical practice is to increase the awareness and involvement of the nursing team in the maintenance of a continuous surveillance system of the process and results of chemotherapy administration in order to increase the quality of care and the safety of the patient. [source] Improving general practitioner records in France by a two-round medical auditJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2002Jean Brami MD Abstract Rationale, aims and objectives,The effectiveness of clinical audits in changing the practice of health care professionals is a moot point. Methods of implementation impinge directly upon outcomes. We investigated whether a network of local opinion leaders could contribute towards a successful audit. Our objectives were to: (i) bring about an improvement in record keeping in general practice; and (ii) increase GPs' awareness of medical evaluation. Methods,The GPs were recruited by local opinion leaders who had been briefed by the French National Agency for Accreditation and Evaluation in Health Care (ANAES, formerly ANDEM). On a given day (first round of the audit) they were invited to examine whether the medical records of their 10 first patients met 13 set criteria. Overall results were analysed by ANAES. Each GP was informed of how well they had fared compared with the regional and national averages and was provided with a standard set of recommendations. Anonymity was ensured by the local leaders. A second round was conducted 6 months later. Results,A total of 244 GPs took part in both rounds of the audit; 32 dropped out after the first round. Their results were of a significantly lower standard. A significant improvement in results (P < 0.025) was recorded between the two rounds for all 13 criteria of the questionnaire. Overall scores improved between the two rounds for 69% of the GPs and improved above average for 49%. The greatest scatter in results was noted for items relating to medical history rather than to personal identity (administrative data). Conclusions,Self-assessment can help improve general standards of medical record keeping. A network of local opinion leaders, briefed by a national agency whose mission is to promote quality improvement in health care, seems to be an effective means of inducing participation in self-assessment. [source] Educating Adaptable Minds: How Diversified Are the Thinking Preferences of Interior Design Students?JOURNAL OF INTERIOR DESIGN, Issue 3 2010Jason Meneely M.S. This study profiled the thinking style preferences of undergraduate interior design students to assess their propensity for employing a wide range of thinking processes. Do interior design students comfortably adapt their thinking across styles or do more entrenched patterns exist within the population? The Herrmann Brain Dominance Instrument was administered to 81 undergraduate interior design students from two programs accredited by the Council for Interior Design Accreditation. Findings indicated that interior design students prefer conceptual, integrative, and expressive modes of thinking but may overlook or avoid analytical, critical, and logical modes. Adaptability between modes of thinking was consistent with normative populations. Educational implications and curricular strategies are discussed. [source] Interior Design in K-12 Curricula: asking the ExpertsJOURNAL OF INTERIOR DESIGN, Issue 3 2007Stephanie A. Clemons Ph.D. ABSTRACT The purpose of this qualitative study was to assess how interior design content areas (subject matter) could be introduced and integrated into elementary and secondary (K-12) grade levels in support of national academic education standards. Although the minimum standards have been developed for entry level interior designers (Council for Interior Design Accreditation [CIDA] Standards, adopted 2002) and beyond (National Council for Interior Design Qualification [NCIDQ]), a gap exists in the interior design education continuum from "kindergarten to career." Between June 2001 to April 2002, in order to understand perceptions of experts in interior design and elementary and secondary education, focus group sessions and personal interviews were conducted with interior design educators and practitioners, K-12 teachers (elementary, junior high, and high school levels), national standards curriculum specialists (local and state levels), and school-to-career curriculum specialists. The goal of the study was to develop a framework that could guide the integration of interior design content into K-12 levels. This paper reports the findings from the focus groups and proposes a framework that could guide the national integration of interior design content into grades K-12, support national academic standards, and suggest possible channels of dissemination for developed interior design curriculum materials. [source] The Present and Future of MFT Doctoral Education in Research-Focused UniversitiesJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 3 2010Douglas H. Sprenkle Doctoral education is greatly impacted by context, and the large majority of marital and family therapy (MFT) doctoral programs are PhD programs in research-focused universities. I believe their primary mission is to equip students to become scientist,practitioners and do original research that will advance the science of the discipline, whereas the mission of the typical master's program is to produce strong practitioners who are research informed. It is the emphasis on the scientific method, not the content specialty area, that should be the hallmark of PhD programs in research-focused contexts. I describe metrics for success that include not only research productivity but also the development of a supportive, open, flexible, and generous program culture. The research mission of these programs has been only modestly helped by the Commission on Accreditation for Marriage and Family Therapy Education process and the programs are largely not doing the programmatic intervention research that the field needs. As the universities that house these programs are also "raising the bar," the long-term viability of the programs themselves will likely hinge on success in this arena. [source] FACTORS INFLUENCING STUDENT SELECTION OF MARRIAGE AND FAMILY THERAPY GRADUATE PROGRAMSJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 1 2007Katherine M. Hertlein To understand which factors students consider most important in choosing a marriage and family therapy (MFT) graduate program and how programs met or did not meet these expectations of students over the course of graduate study, we conducted an online mixed-method investigation. One hundred twelve graduate students in Commission on Accreditation for Marriage and Family Therapy Education-accredited programs responded to an online survey assessing what factors led them to select a specific graduate program in MFT. In the quantitative portion, students ranked each factor (personal fit, faculty, funding, research, clinical work, and teaching) as well as characteristics of each factor in relation to its importance in their selection of an MFT program. Additionally, students indicated to what level their programs meet their expectations. In the qualitative portion, students described how they believed their chosen program was or was not meeting their expectations. Both doctoral and master's students ranked personal fit as the top factor affecting their choice of graduate program in MFT, but they differed on the characteristics of each of these factors and their importance in selecting an MFT program. Implications for this research include program evaluation and program advertising, and are consistent with the scientist,practitioner model. [source] TEXTUAL REPRESENTATION OF DIVERSITY IN COAMFTE ACCREDITED DOCTORAL PROGRAMSJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 1 2006John J. Lawless The use of the Internet is growing at a staggering pace. One significant use of the Internet is for potential students and the parents of potential students to explore educational possibilities. Along these lines potential marriage and family therapy students may have many questions that include a program's commitment to cultural diversity. This study utilized qualitative content analysis methodology in combination with critical race theory to examine how Commission On Accreditation for Marriage and Family Therapy Education (COAMFTE) accredited doctoral programs represented cultural text on their World Wide Web pages. Findings indicate that many COAMFTE-accredited doctoral programs re-present programmatic information about diversity that appear to be incongruent with cultural sensitivity. These apparent incongruities are highlighted by the codification, inconsistent, and isolated use of cultural text. In addition, cultural text related to social justice was absent. Implications and suggestions are discussed. [source] A college president's defense of accreditationNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 145 2009Robert A. Oden Accreditation may be the sole opportunity for all parts of an institution to inquire together and in depth about the totality of their mission. [source] Accreditation and the Credit HourNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 122 2003Jane V. Wellman Accreditation, the process of peer review to ensure the quality of a degree program, has depended on institutions measuring degree content in student credit hours. [source] Distance Education and AccreditationNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 113 2001Watson Scott Swail Distance learning and technology have taken on a life of their own in higher education. We need to find a way of assessing distance-education programs that breaks away from traditional accreditation standards. [source] From Consensus Standards to Evidence of Claims: Assessment and Accreditation in the Case of Teacher EducationNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 113 2001Frank Brush Murray To what extent should accreditation focus on the processes of assessing student learning outcomes, and to what extent should it primarily be concerned with the levels of student attainment within the institution or program under review? There is a need to evaluate the purposes of procedural and substantive standards and the claims they make about graduates' competence. [source] Type 2 Diabetes: Fueling the Surge of Cardiovascular Disease in WomenNURSING FOR WOMENS HEALTH, Issue 6 2008Emily J. Jones BSN Objectives Upon completion of this activity, the learner will be able to: 1Recognize and identify the interrelated risk factors that contribute to the development of type 2 diabetes and cardiovascular disease (CVD) in women. 2Formulate strategies that result in the early identification of women at risk for developing type 2 diabetes and CVD. 3Describe intervention strategies for the prevention and treatment of type 2 diabetes and CVD in women. Continuing Nursing Education (CNE) Credit A total of 2 contact hours may be earned as CNE credit for reading "Type 2 Diabetes: Fueling the Surge of Cardiovascular Disease in Women" and for completing an online post-test and participant feedback form. To take the test and complete the participant feedback form, please visit http://JournalsCNE.awhonn.org. Certificates of completion will be issued on receipt of the completed participant feedback form and processing fees. AWHONN is accredited as a provider of continuing nursing education by the American Credentialing Center's Commission on Accreditation. Accredited status does not imply endorsement by AWHONN or ANCC of any commercial products displayed or discussed in conjunction with an educational activity. AWHONN also holds California and Alabama BRN numbers: California CNE provider #CEP580 and Alabama #ABNP0058. [source] Identification and prioritization of quality indicators in clinical genetics: An international survey,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2009Barbara C. Zellerino Abstract The range and demand for clinical genetic services will continue to grow, and now is an ideal time to assess current service quality. Based on the previous work of quality professional organizations such as the Institute of Medicine (IOM) and The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) which is now known as The Joint Commission (TJC), an independent group of genetic and healthcare quality professionals (InheritQual) drafted and defined a list of potential quality indicators for clinical genetics. Perspectives on the appropriateness and the practicality of each indicator were surveyed and analyzed. The Quality Special Interest Group of the American College of Medical Genetics (ACMG) chartered the survey results. After measuring the degree of consensus, an expert panel was selected to review the quality indicators based on practicality and applicability. This expert panel comprised of members of the ACMG Quality Sig workgroup met for final consensus and developed a methodology to pilot these indicators. © 2009 Wiley-Liss, Inc. [source] Ensuring the Preconditions for Transformation Through Licensing, Regulation, Accreditation, and StandardsAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2007Robert E. Lieberman MA Residential treatment is a potentially powerful intervention for children and families, currently facing the imperative to fundamentally change practice models to achieve greater quality efficacy, efficiency, and effectiveness. Such transformation is best accomplished from a solid foundation which is created by licensing, regulation, accereditation, and internal standards. [source] Impact of Disaster Drills on Patient Flow in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 6 2008Nathan Timm MD Abstract Objectives:, Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-accredited hospitals must conduct disaster drills twice a year, with one incorporating a mass casualty incident to the emergency department (ED). The authors found no studies describing the potential negative impact on the quality of care real patients in the ED receive during these drills. The objective was to determine the impact that mass casualty drills have on the timeliness of care for nondisaster patients in a pediatric ED. Methods:, Since 2001, nine disaster drills involving mass casualties to the ED were conducted at the authors' institution. The authors studied 5-, 10-, and 24-hour blocks of time surrounding these events and defined quality measures as the timeliness of care in terms of length of stay (LOS) in ED, time-to-triage, and time-to-physician. Drill dates were compared with control dates (the same weekday on the following week). Paired t-tests were used to compare outcomes of interest between drill and control days. Results:, Nine drill days and nine control days were studied. There was no statistically significant difference between drill dates and control dates in average time-to-triage and time-to-emergency physician and average ED LOS. Admitted patients spent less time in the ED during drill dates. Conclusions:, Disaster drills at this institution do not appear to significantly affect the timeliness of care to nondisaster drill ED patients. Attention should be paid to the quality of care "real" patients receive to ensure that their care is not jeopardized during an artificial stress to the system during a disaster drill. [source] The National Trend in Quality of Emergency Department Pain Management for Long Bone FracturesACADEMIC EMERGENCY MEDICINE, Issue 2 2007PA-C, Tamara S. Ritsema MPH Background Despite national attention, there is little evidence that the quality of emergency department (ED) pain management is improving. Objectives To compare the quality of ED pain management before and after implementation of the Joint Commission on the Accreditation of Healthcare Organizations' standards in 2001. Methods The authors performed a retrospective cohort study by using the National Hospital Ambulatory Medical Care Survey from 1998,2003. Patients who presented to the ED with a long bone fracture (femur, humerus, tibia, fibula, radius, or ulna) were compared. The authors extracted data on patient, visit, and hospital characteristics. The primary outcomes were the proportion of patients who received assessment of pain severity and who received analgesic treatment. Results There were 2,064 patients with a qualifying fracture in the study period, 834 from 1998,2000 and 1,230 from 2001,2003. Compared with the early period, a higher proportion of patients in the late period had their pain assessed (74% vs. 57%), received opiates (56% vs. 50%), and received any analgesic (76% vs. 56%). Patients in the late period had higher odds of receiving any analgesia (adjusted odds ratio [OR], 1.43) and opioid analgesia (adjusted OR, 1.27) compared with the early period. Patients in the middle age group (adjusted OR, 2.28) or those seen by physician assistants (adjusted OR, 2.05) were more likely, whereas those with Medicaid (adjusted OR, 0.58) and those in the Northeast were less likely, to receive opiates. Conclusions Although the quality of ED pain management for acute fractures appears to be improving, there is still room for further improvement. [source] Pain Assessments and the Provision of Analgesia: The Effects of a Templated ChartACADEMIC EMERGENCY MEDICINE, Issue 1 2007Brigitte M. Baumann MD Abstract Objectives Many emergency departments (EDs) have incorporated pain assessment scales in the medical record to improve compliance with the requirements of the Joint Commission on Accreditation of Healthcare Organizations. The authors conducted a pre-post trial investigating the effects of introducing a templated chart on the documentation of pain assessments and the provision of analgesia to ED patients. Methods A total of 2,379 charts were reviewed for inclusion based on the presence of a chief complaint related to trauma or nontraumatic pain, with 1,242 charts included in the analysis. Results Baseline demographic characteristics, mechanism of injury, location of injury, and initial pain severity were similar in the two groups. The proportion of patients with documentation of pain assessment increased from 41% to 57% (p < 0.001). In particular, traumatic mechanisms and chest, abdominal, and extremity pain yielded the largest improvements in documentation after introduction of the templated charts. Documentation of pain descriptors also improved for time of onset, duration, timing, and context (p < 0.01). Pain control in the templated chart group, however, remained unchanged and the provision of analgesia in the ED was not altered, with the exception of nonsteroidal medications, which decreased from 46% to 36% (p < 0.01). Conclusions Although documentation is improved with a templated chart, this improvement did not translate into improved patient care. [source] Quality Assurance/Accreditation in the Emerging European Higher Education Area: a possible scenario for the futureEUROPEAN JOURNAL OF EDUCATION, Issue 3 2003Guy Haug First page of article [source] CPA assessment , the regional assessors' experienceCYTOPATHOLOGY, Issue 2007E. Welsh Many individuals within Laboratory Medicine will be unaware that CPA conducts assessments to two different sets of CPA Standards. There are the Standards for the Medical Laboratory and the Standards for EQA Schemes in Laboratory Medicine. The style and format of both sets of standards is very similar with each being presented in eight sections A , H. The EQA standards are almost identical to the laboratory standards with the exception of the E.F and G standards which are specific to EQA schemes. There are approximately 40 EQA Schemes registered with CPA compared with almost 2 500 laboratories. These EQA schemes vary from very large national/international schemes with numerous analytes to small interpretive schemes run by one individual with a personal interest in that specific subject. The large schemes usually come under the UKNEQAS consortia banner and due to their size and configuration do not present undue problems in the assessment process. Smaller interpretive EQA schemes present a challenge both for the scheme and CPA in gaining accreditation. These schemes are usually within the discipline of Histopathology and are regarded as educational rather than proficiency testing schemes. Very frequently, the scheme is organized by a single individual with a collection of microscope slides, storage facilities for the slides and a computer. This presents the Scheme Organizer with great difficulty in complying with the Quality Management System requirements of the CPA Standards. There are a number of models which can be applied in order to satisfy the requirement of the Quality Management System, but ultimately it must be recognized that in some circumstances it is not possible to accredit these small schemes. The NHSCSP Gynae Cytology EQA Scheme is probably the largest EQA scheme within the UK, in respect of the number of participants and the number of staff supporting the scheme. Scheme Management decided that all nine regions of England would apply for accreditation under one CPA Reference Number. This process meant that the scheme would be assessed as a Managed Pathology Network. This is unique in terms of EQA schemes and presented a number of problems not previously encountered in EQA scheme accreditation. This decision meant that all nine regions must comply with a single Quality Management System and other CPA standards whilst allowing flexibility within the system for each region to facilitate the assessment process specific to their user's requirements. The process worked in a satisfactory manner and the overall outcome was not dissimilar to that of other large EQA schemes. The assessment to the current EQA Standards only commenced in April 2006 whilst the Standards for Medical Laboratories commenced in 2003, and it is perhaps not surprising to find that the principal non-conformities are related to the Quality Management System. This parallels the findings encountered in laboratory accreditation. There is an ongoing educational process for Scheme Management and the Facilitators in each region in how to comply fully with the standards and a commitment to quality improvement which ultimately is beneficial to the participant's of the scheme and to patient safety. [source] | |||||||||||||||||||||||||