Australian clinical review最新文献

During 1988 and 1989 several patients developed severe pressure areas post operation. The patients all underwent major surgery lasting a few hours and experienced haemodynamic complications as a result of their condition in the peri-operative period. Although these pressure areas did not develop while the patients were in the operating theatres it was thought that the duration of their surgery contributed to the problem. In order to determine the extent of pressure area development on patients undergoing surgery it was decided to undertake an extensive quality assurance audit over a 3 month period. The sample of 108 patients included patients from cardiothoracic, orthopaedic and plastic microvascular, ear, nose and throat, ophthalmology, vascular, urology and general surgery plus a control group of patients whose surgery was less than 1 h duration. The patients were visited pre-operatively to assess their skin integrity. Intra-operative pressure care management plus other relevant information was documented. A second visit at 24 h post operation determined whether any changes in skin integrity had developed. The results of the surgery were not significant when the whole sample was looked at. However, they did become statistically significant when broken down into specialty groups. The recommendations of the survey included research into the improvement of operating table mattresses and contoured positioning devices. An education programme of staff was to be undertaken to develop greater awareness of the problem.

American studies on Diagnosis Related Groups (DRG) coding errors have suggested large error rates. However, we are aware of no Australian data on the extent and significance of errors in completion and encoding of front sheet diagnosis/procedure information on DRG grouping of hospital separations. With the imminence of casemix funding in Australia, this topic takes on a greater significance. We therefore undertook a pilot research study to assess this. At each of three hospitals in the Hunter Area Health Service, NSW (one teaching, one acute general district hospital and one rural general practitioner hospital), we attempted to sample 150 records. A committee reviewed the charts and assessed coding, DRG and Major Diagnostic Category (MDC) error rates. These were 8.1-9.6% for DRG allocation and 3.4-5.2% in MDC allocation. Using current casemix funding data, one of the hospitals would have suffered a funding shortfall for inpatient services of nearly $2 million or 2.6% of total budget at that time. If these data, extracted after an exercise to reduce errors in DRG and front sheet coding, are representative, then there are major implications for hospital inpatient funding if casemix funding is introduced. Major educational exercises are called for the further in-depth research may prove useful.

Hospital accreditation has been criticized for its emphasis on structure and documentation. Less attention is given to the clinical process and outcomes of care. How can the accreditation process become a meaningful part of day-to-day hospital management? Four approaches are discussed. (1) The development of industrial type quality assurance programmes that detect negative patient outcomes and improve patient care. (2) The appointment of a Quality Assurance/Accreditation Coordinator with appropriate authority. (3) The establishment of an effective Quality Assurance/Accreditation Committee. (4) The continuous review of accreditation standards through normal committee function and department review, and trial surveys. Such strategies will enable hospital accreditation to develop beyond a paper exercise and to provide the foundation for excellence in health care delivery.

The Australian Diabetes Educators Association (ADEA) has undertaken policy development aimed at maintaining standards of practice and increasing professional skills. The components of a quality assurance framework have been identified and committees established to operationalize the objectives. Implementation of quality assurance projects has benefits for consumers and providers of health care. Knowledge and skills developed in the process of implementing quality assurance initiatives increase professional awareness and can be adapted to broaden practice parameters and create practice opportunities. This paper describes the approach to quality assurance developed by the committees and working parties of the ADEA that could be implemented in part or whole by professional groups seeking to ensure quality services by members.

Queensland Health is trialling an integrated package of projects aimed at reducing lengths of stay in public hospitals, providing continuity and quality of care from admission to an acute-care facility through to the completion of the episode in the community. Service gaps and reasons for delayed discharge are identified; funds are provided for the purchase of care for individual patients/clients; and the interface between hospital and community is co-ordinated. Multi-disciplinary teams, including the patient's own general practitioner, co-operate in the referral process for the provision of care within the community. Clinical nurse consultants monitor quality aspects from the community perspective. Implementation has been approached in different ways, at different sites. Education of key players is an important variable in the success of the project.

A brief account of the obstacles faced during the introduction of hospital accreditation in Australia is provided, with some insight into the politics of change in health care. Some observations are made concerning critical elements of the accreditation program and the implications for the future of the Australian Council on Healthcare Standards.

This paper reviews the introduction and results of an Outcome Assessment system developed to determine if all women delivering at the Royal Women's Hospital, Brisbane were receiving an acceptable level of care. The system involves measurement of four outcome variables: nosocomial infection rate; medication error rate; accident rate; and a comprehensive patient questionnaire. Scores are combined and a monthly Quality of Care Score, and other information including the Caesarean delivery rate, bed occupancy rate, number of primiparas in the ward and percentage of women who failed to achieve a minimum acceptable score, is prepared for each ward. On another level, the system allows midwives to objectively evaluate the care provided in their ward by involving each patient's primary midwife, clinical nurse consultant and unit manager in the collection and review of data. The monthly feedback to wards, the Director of Nursing, Chief Executive Officer, Dietitian and Senior Domestic Supervisor has resulted in changes which had previously been difficult to achieve.

It is essential for the health care industry to demonstrate a quality service. The Canterbury Area Health Board (CAHB), New Zealand is in the process of establishing the principles of Total Quality Management (TQM) and this paper addresses the key issues of committing to TQM. Highlighted are the Board's implemented programmes, business plan and role of the health care industry.

An analysis of patient accidents occurring at St Vincent's Hospital, Sydney in 1990 was undertaken using data obtained from the hospital's computerized accident database. Ward, age and sex specific fall rates were calculated from a total of 800 patient-related accidents and incidents reported. Ninety per cent of all accidents were falls, the majority occurring in patients over the age of 60 years. Female patients experienced a significantly greater rate of accidents than male patients (P < 0.05). No significant difference in the overall fall rates for males and females was found. However males 50 years of age and under were almost twice as likely to fall as females in this age group. More than 50% of patients who fell sustained an injury; 4% of these were serious injuries. The geriatric, neurosciences and HIV wards had the highest rates of patient falls. Nearly 40% of falls involved only 77 patients who fell on multiple occasions. Preventative strategies are discussed. Patient accident data from other Australian hospitals is required for adequate assessment of the incidence of patient accidents.

This paper explores the concept of quality in relation to nursing care and the contribution of quality assurance to its achievement. A descriptive study involving the administration of a questionnaire to all registered nurses in the clinical area employed at Osborne Park Hospital, Perth, Western Australia was undertaken to examine these issues. Overall, respondents had a positive attitude towards quality and quality assurance, although the latter concept appeared to be better understood. Quality assurance was viewed as an effective activity for reviewing and changing nursing practice and for helping to achieve quality nursing care. However, the study also demonstrated a need for further education in skills associated with quality assurance activities. Several other barriers to participating in quality assurance and to delivering quality care were identified.