QRB. Quality review bulletin
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The Foundation for Health Care Quality (Washington) used three administrative public databases and indicators recommended by the Joint Commission and the American College of Obstetrics and Gynecology to build algorithms to measure quality of obstetric care in the state of Washington. Analyses demonstrated a high degree of variability across hospitals for major processes of care such as cesarean section, vaginal birth after cesarean section, and forceps deliveries. ⋯ Sixty-two percent believed the information was useful for initiating quality improvement projects. Of the 25 indicators tested in the project, indicators rated as most useful were the same 10 obstetric indicators chosen by the Joint Commission after alpha testing.
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This study assesses the effects of a status asthmaticus guideline on patient outcome and pediatrician behavior in a staff model health maintenance organization (HMO). The guidelines were drafted by an asthma specialist in the HMO and then discussed with key clinical personnel. ⋯ The medical records of pediatric patients admitted to the hospital with status asthmaticus before (N = 67) and after (N = 59) guideline development and implementation were reviewed. This study demonstrates that locally developed, treatment-specific guidelines based on scientific evidence and combined with a staff consensus process and a user-friendly protocol form can influence physician behavior and patient outcome positively.
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The authors suggest that the lack of consensus among nurses about important indicators and other measures of quality stems from the lack of consensus on important aspects of nursing care. This article reports on a national conference for nursing quality assurance in which 176 nurses representing 11 specialties developed lists of universal and specialty practice important aspects of care. It discusses questions raised at the conference about definitions of terms, as well as plans for additional follow-up work.
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In 1990, Schumpert Medical Center, Shreveport, Louisiana--a 625-bed acute care hospital--established an acute pain service (APS) department and implemented the ten-step monitoring and evaluation process as recommended by the Joint Commission to facilitate the quality assurance program for pain management therapy. The program, which entails the cooperative effort of anesthesiologists and registered nurses, is intended to provide individualized pain management therapy to qualified APS patients on a 24-hour, seven-day-a-week basis. Through continuous, systematic monitoring and evaluation of six aspects of care and their indicators and thresholds, the quality of APS patient care can be determined and improved.