Patient safety and quality improvement

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Patient safety and quality improvement

Karl A. Poterack, MD

Although patient safety and quality improvement (QI) have been priorities for health care institutions for some time, it was the 2006 report of the Institute of Medicine highlighting the morbidity and mortality risks associated with iatrogenic injury in hospitals that captured the public’s interest. Although the report has many problems, the chief executive officers of Fortune 500 companies and third-party payers found the report to be in keeping with their thoughts on the health care industry: reimbursement for health care was increasing at double-digit rates every year, but outcomes were no better, and days of work lost due to illness were not decreasing. Accordingly, over the last several years, QI and the safety of patients in health care institutions has garnered more publicity and increased emphasis on safety.

Quality improvement

QI is a strategy to guide individual and group decision making. It has its roots in engineering and manufacturing, where systems theory and statistical process control were combined with general management methods. It is variously defined as the reduction of variability in products and processes and as an organized process that assesses and evaluates health services to improve practice or quality of care. International Organization for Standardization (ISO) standard 8402-1986 defines quality as “the totality of features and characteristics of a product or service that bears its ability to satisfy stated or implied needs.” The Institute of Medicine defines health care quality as “the extent to which health services provided to individuals and patient populations improve desired health outcomes.” W. Edwards Deming defined quality as “meeting customer requirements at a price they are willing to pay.”

QI programs in anesthesiology are guided by requirements of regulatory bodies, such as state law, Center for Medicare Services, and The Joint Commission. Unfortunately, many clinicians view QI programs as being driven solely by mandates of these external regulatory groups, which results in the whole system being perceived as “red tape” and “overhead” that add cost but no real value. Such an approach can easily become a self-fulfilling prophecy by consuming resources through the production of unread reports and paperwork, thus diverting resources that could be devoted to actually increasing quality.

Different elements of a QI program may focus on the structure, process, and outcome of health care delivery programs. Structure refers to the setting in which care is provided, (e.g., personnel, facilities, and how they are organized); process, to the patient care activities that are performed; and outcome, to any changes in the patient’s health after the care was performed. QI programs, therefore, address all areas of hospital operations. An adverse event then, is an untoward, undesirable, and usually unanticipated event, such as the death of a patient, but also of an employee or a visitor in a health care organization. Incidents such as patient falls or improper administration of medications are also considered to be adverse events even if the event has no permanent effect on the patient. A medical error is an adverse event or near miss that is preventable with the current state of medical knowledge, and a sentinel event is a single isolated event that may indicate a systems problem.

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