Quality Assurance Department Research Articles

The Oral Care Link Nurse: a facilitator and educator for maintaining oral health for patients at the Royal Hospital for neuro-disability.

This paper describes an ongoing oral health education project developed and implemented at the Royal Hospital for Neuro-disability (RHN) by the Dental Team. The Oral Care Link Nurse (OCLN) project was developed to assist the dental team in the promotion of oral care within the hospital. The Dental Team identified that, in addition to providing knowledge and skills to perform effective oral care, it is important that nursing staff retain positive attitudes and behavior toward providing that care. In conjunction with the Quality Assurance department, oral care guidelines were introduced throughout the hospital, with further input being focused on the training of at least one unqualified nursing auxiliary from each ward. These became the OCLN who were trained by the Dental Team to assist with the promotion of good oral care practices on the wards and to aid communication regarding patient oral health within the multidisciplinary team. Formal evaluation, by clinical audit, indicated that the project continued to improve the overall standard of oral care throughout the hospital. To ensure that this high standard continues, it is essential that continued support, commitment, and enthusiasm be given from the dental team and that support is constant.

GCP auditors: hard to find—hard to develop—hard to keep: part II. Initial training requirements for auditors

A well-planned training programme, with a clear understanding of the necessary training modules, is the first step towards developing highly skilled good clinical pracice (GCP) auditors. If the training programme is carefully administered by senior quality assurance (QA) personnel and the auditor's progress is regularly monitored, training results will be successful. Consistency of audit approach and working style in the QA department will be promoted. Training is not an event, but a process. As soon as the initial training is completed for a new auditor, a plan should be available for continuous education of GCP auditors. Copyright © 2000 John Wiley & Sons, Ltd.

A pilot scheme for the development of evidence-based practice.

This article presents an evaluative account of a pilot scheme that aimed to introduce evidence-based practice in one NHS trust. The scheme was based on collaboration between staff in the quality assurance department and a nurse researcher based in a university. This collaboration enabled three designated staff to develop skills required for evidence-based practice and guide the production of information that could be disseminated to nurses throughout the trust. Evaluation demonstrated that participants had examined eight practice-based topics and devised protocols that could be applied to practice in a range of hospital and community settings throughout the trust. Evaluation also highlighted the importance of ensuring that members of other disciplines are aware of, and feel involved in, new developments even if they are not directly concerned with them.

Implementation of and experiences with new automation

In an environment where cost, timeliness, and quality drives the business, it is essential to look for answers in technology where these challenges can be met. In the Novartis Pharmaceutical Quality Assurance Department, automation and robotics have become just the tools to meet these challenges. Although automation is a relatively new concept in our department, we have fully embraced it within just a few years. As our company went through a merger, there was a significant reduction in the workforce within the Quality Assurance Department through voluntary and involuntary separations. However the workload remained constant or in some cases actually increased. So even with reduction in laboratory personnel, we were challenged internally and from the headquarters in Basle to improve productivity while maintaining integrity in quality testing. Benchmark studies indicated the Suffern site to be the choice manufacturing site above other facilities. This is attributed to the Suffern facility employees' commitment to reduce cycle time, improve efficiency, and maintain high level of regulatory compliance. One of the stronger contributing factors was automation technology in the laboratoriess, and this technology will continue to help the site's status in the future. The Automation Group was originally formed about 2 years ago to meet the demands of high quality assurance testing throughput needs and to bring our testing group up to standard with the industry. Automation began with only two people in the group and now we have three people who are the next generation automation scientists. Even with such a small staff,we have made great strides in laboratory automation as we have worked extensively with each piece of equipment brought in. The implementation process of each project was often difficult because the second generation automation group came from the laboratory and without much automation experience. However, with the involvement from the users at ‘get-go’, we were able to successfully bring in many automation technologies. Our first experience with automation was SFA/SDAS, and then Zymark TPWII followed by Zymark Multi-dose. The future of product testing lies in automation, and we shall continue to explore the possibilities of improving the testing methodologies so that the chemists will be less burdened with repetitive and mundane daily tasks and be more focused on bringing quality into our products.

Collaborative networks with private doctors to conduct joint clinical studies in Leipzig/Germany

Collaborative networks of doctors to conduct joint clinical studies in the greater area of Leipzig were set up in early 1998 involving 28 rheumatologists, 67 orthopaedic surgeons, 10 oncologists and 197 general practitioners (GPs). Private doctors refer their patients solely for possible inclusion in clinical studies. Their main task is selection of patients, that also includes an explanation of the study and assessment of the motivation of their patients. The clinical studies are carried out at the Clinical Study Centre: “Centre for Therapeutic Studies” (Zentrum fur Therapiestudien, ZET e.V.). In two large scale studies in rheumatoid arthritis and osteoarthrosis, respectively, the ZET e.V. ranked in the top three centres with regard to recruitment of suitable patients amongst more than 100 centres internationally. Results of an audit by the international quality assurance department of the sponsor revealed no GCP relevant findings. In conclusion, the principle of collaborative networks with private doctors may open new avenues for doing clinical research in Germany.

Contracts: Third Circuit Upholds Limited Immunity of Peer Review Actions Under HCQIA

The U.S. Court of Appeals for the Third Circuit held, in Brader v. Allegheny General Hospital, 167 E3d 832 (3rd Cir. 1990), that the Health Care Quality Improvement Act (HCQIA), 42 U.S.C. §§ 11101-11152 (1986), shields a Pennsylvania hospital from a surgeon's claims of contract violations.The plaintiff, Alan Brader, M.D., joined Allegheny General Hospital's (AGH) provisional medical staff in July 1988. During the next two years, he performed several abdominal aortic aneurysm (AAA) repairs and various other operations. Several of Brader's patients sustained serious injuries or died during surgery from complications. In 1989, Brader's supervisors, Drs. Daniel Diamond and George Magovern, met to discuss their dissatisfaction with Brader's behavior, his departures from hospital protocol, as well as his disruptive presence in the hospital. From 1989 to 1990, Brader continued to perform surgical procedures on incoming patients, and he continued to violate hospital notification protocol and lost a patient during surgery. In spring 1990, the Quality Assurance Department (QAD) compiled data on AAA procedures for the hospital's physicians.

1 A Proven Approach to Driving Quality into the Bottom Line

AbstractToday's software development efforts need a conscience to drive quality into the bottom line. Historically, software development efforts have been overrun and delivered late, and unfortunately, the quality has suffered. A “proven” roadmap to achieving mission success for the quality assurance organization as well as the program will be provided in this paper. The approach has been taken with several programs contributed to improving total customer satisfaction, improving productivity, improving the reputation of the Quality Assurance department and growing the business.

The Challenge of Auditing Clinical Laboratories

Three types of clinical laboratory audits-local (clinical trial center), core, and central laboratory audits-are conducted by the Roche Pharma Research Quality Assurance (PRQA) Department. All laboratory audits are designed to determine if the laboratory data are reliable and verifiable, if there are adequate procedures and facilities, and to clarify the status of reference ranges and source document archiving. Audits are conducted on the basis of the good clinical practice (GCP) guidelines and regulations (1,2); national laboratory requirements, for example, Clinical Laboratory Improvement Amendment (CL1A) regulations (3) or the “Guide de bonne execution des analyses” (GBEA) (4); and, where applicable, international principles of good laboratory practices. The approach of the three audit types together with their common audit findings is described below. It was found that each type of clinical laboratory audit had revealed its own characteristic audit findings. Follow-up actions were implemented both by the clinical laboratory and the sponsor. For example, Roche’s Clinical Research Department is now requiring a precontract audit before most agreements with core/central laboratories as well as follow-up, during-contract audits with preferred central laboratories. Improved quality and greater efficiency were achieved when all partners on the team (clinical research, clinical laboratories, and quality assurance) worked together.

A quality assurance model for an information system development life cycle

Proposes a quality assurance model for the development of a computer‐based information system covering the different system life cycle stages. A field investigation for the information systems in a selected number of organizations in Kuwait revealed that a limited number of organizations have a quality assurance department, and limited evaluation procedures were implemented. Emphasizes the need for applying the concept of quality assurance to obtain a high quality of software product.

Response

Magnetic Resonance in MedicineVolume 36, Issue 3 p. 499-501 Letters to the EditorFree Access Response Leoncio Garrido, Leoncio Garrido Biomaterials Laboratory, NMR Center Department of Radiology Massachusetts General Hospital and Harvard Medical School Charlestown, MA 02129Search for more papers by this authorJerome L. Ackerman, Jerome L. Ackerman Biomaterials Laboratory, NMR Center Department of Radiology Massachusetts General Hospital and Harvard Medical School Charlestown, MA 02129Search for more papers by this author Leoncio Garrido, Leoncio Garrido Biomaterials Laboratory, NMR Center Department of Radiology Massachusetts General Hospital and Harvard Medical School Charlestown, MA 02129Search for more papers by this authorJerome L. Ackerman, Jerome L. Ackerman Biomaterials Laboratory, NMR Center Department of Radiology Massachusetts General Hospital and Harvard Medical School Charlestown, MA 02129Search for more papers by this author First published: September 1996 https://doi.org/10.1002/mrm.1910360329Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 L. Garrido, B. Pfleiderer, B. J. Jenkins, C. A. Hulka, D. B. Kopans, Migration and chemical modification of silicone in women with breast prostheses. Magn. Reson. Med. 31, 328– 330 (1994). 2 P. Macdonald, N. Plavac, W. Peters, S. Lugowski, D Smith, Failure of 29Si NMR to detect increased blood silicon levels in silicone gel breast implants. Anal. Chem. 67, 3799– 3801 (1995). 3 L. Garrido, B. Pfleiderer, M. Papisov, J. L. Ackerman, In vivo degradation of silicones. Magn. Reson. Med. 29, 839– 843 (1993). 4 B. Pfleiderer, J. L. Ackerman, L. Garrido, Migration and biodegradation of free silicone from silicone gel-filled implants after long-term implantation. Magn. Reson. Med. 30, 534– 543 (1993). 5 L. W. Lets, N. J. Effinger, S. M. Melpolder, Sol-gel chemistry studied by 1H and 29Si nuclear magnetic resonance. J. Non-Cryst. Solids. 83, 353– 374 (1986). 6 L. Garrido, J. E. Mark, C. S. Sun, J. L. Ackerman, C. Chang, NMR characterization of elastomers reinforced with in situ precipitated silica. Macromolecules 24, 4067– 4072 (1991). 7 L. Garrido, J. L. Ackerman, Re: Do patients with silicone-gel breast implants have elevated levels of blood silicon compared with control patients? Ann. Plast. Surg. 34, 505– 507 (1995). 8 S. S. Teuber, R. L. Saunders, G. M. Halpern, R. F. Brucker, V. Conte, B. D. Goldman, E. E. Winger, W. G. Wood, M. E. Gershwin, Elevated serum silicon levels in women with silicone gel breast implants. Biol. Trace Elem. Res. 48, 121– 130 (1995). 9 S. K. McCoy, Factors affecting the integrity and stability of Q7–2159A mammary gel and intermediates. Dow Corning Quality Assurance Department, Report #0058, Series #I 0057, Dow Corning Co., Midland, MI, 1987. 10 D. L. de Camara, J. M. Sheridan, B. A. Kammer, Rupture and aging of silicone gel breast implants. Plast. Reconstr. Surg. 91, 828– 836 (1993). 11 O. G. Robison, E. L. Bradley, D. S. Wilson, Analysis of explanted silicone implants: a report of 300 patients. Ann. Plast. Surg. 34, 1– 7 (1995). Citing Literature Volume36, Issue3September 1996Pages 499-501 ReferencesRelatedInformation

Sources of Nutritional Information for Menu Development And Modification:: A Comparison of Quick-service, Midscale and Upscale Chain Restaurants

LEARNING OUTCOME: To examine sources of nutritional information used in menu development and modification by quick-service, midscale and upscale chain restaurants.The objective of this preliminary investigation was to determine and compare sources of nutritional information used by quick-service, midscale and upscale chain restaurants. The pre-test instrument was evaluated and completed via a pilot study involving members of the population. Content validity and clarity were established. The instrument was sent to all 309 members of the population, directors of product research and development for U.S.-based restaurant chains with the greatest annual volume. A total of 105 (34.0%) usable responses was obtained: quick-service (37.1%); midscale (27.6%); upscale (24.8%); and corporations representing more than one industry segment (10.5%). For quick-service chains results indicated the most frequent sources utilized for nutritional expertise were: external laboratory company for nutritional analysis (82.1%); corporate quality assurance department (64.1%); in-house registered dietitian, RD. (28.2%); external consultant (25.6%); and American Heart Association, AH. A (15.4%). Sources for midscale chains were: corporate quality assurance department (51.7%); external laboratory (41.4%); in-house RD. (17.2%); AH.A. (10.3%); and external consultant (10.3%). Upscale chains utilized: corporate quality assurance department (73.1%); external laboratory (57.7%); external consultant (26.9%); A.H.A. (15.4%); and in-house R.D. (11.5%). Sources utilized by corporations representing more than one industry segment were: corporate quality assurance department (45.5%); external laboratory (36.4%); external consultant (18.2%); and in-house R.D. (9.1%). Collectively, the two top sources of nutritional information utilized were corporate quality assurance departments (64.0%) and external laboratories (63.0%), while 20.0% of the chains have their own R.D. However, 28.0% of the quick-service restaurant corporations employ R.D.s. It is critical for R.D.S in various roles to increase interactions with restaurant operators to promote accurate nutritional information and healthful eating alternatives for consumers away from home.

Fraud and Misconduct in Clinical Research: Company Dilemmas and Solutions

It is through intent that fraud differs from error and poor quality. There are different types of fraud: falsification of data, invention of data, or absence or falsification of informed consent. Most often, it is the investigator who commits fraud, or at least fraud is most often committed under his responsibility. The detection of fraud can be easy when there is direct proof, moderately difficult when there is presumed proof, and more difficult with indirect proof. Each company has its own procedures to handle fraud, but nevertheless several points may be highlighted: responsibility should be taken by senior management, compilation of the dossier should be done by the quality assurance department, and an external audit should be systematically carried out. The company should set standards for various degrees of fraud, so that decisions are not made on a study-by-study basis. To set these standards, a committee could be set up following the English (representatives of companies and physicians) or Danish ...

Using Pharmacist Clinical Intervention Data for Quality Improvement of Medication Use and Physician Assessment

Patient-specific intervention data are often used for drug usage evaluation (DUE), but their use in physician assessment is less often discussed. In response to the quality assurance department's request, the pharmacy department at the Medical College of Georgia (Augusta) developed a database and a reporting system that supports quality assessment of the medical staff, identifies housestaff education needs, and directs efforts for improvement in medication use. THE REPORTING SYSTEM: In 1991 the comprehensive, concurrent screening of drug therapy by pharmacists formed the foundation of the hospital's DUE program. Each month information from the pharmacy database is sorted with use of a spreadsheet software program to generate medical department-level reports and for use in physician reappointment. Identified performance deficiencies can be used to educate individual prescribers and to develop educational programs for the department or specialty areas. Feedback from the medical staff assessment is useful for pharmacist education, such as identifying newly reported indications and dosage regimens. During the first six months after all pharmacists began participating in the reporting program, a mean of 224 interventions were recorded monthly. For the period January through June 1994, 400-550 interventions were recorded monthly. System improvements in medication during the first year of implementation included hospitalwide guidelines for parenteral potassium and phosphate dosing and administration and a renewed focus on patient allergies. Emphasis for use of intervention data has shifted from identifying "problem" persons to improving performance by identifying topics for corrective education and redesigning systems to promote positive patient outcomes.

Implementing TQM in a Military Hospital in Saudi Arabia

Health care services in the Kingdom of Saudi Arabia are unique not only in the varied patient population served and multinational staff recruited to provide services, but also because they are not driven by financial or medicolegal constraints. As part of a five-year plan (carried out in four phases) to improve the quality of health care provided in the Kingdom, the North West Armed Forces Hospitals (NWAFH) in Tabuk became the first health care facility in the Kingdom to implement total quality management (TQM). This was not an implementation de novo, but a well-coordinated transition from quality assurance (QA) to TQM. The hospital leadership believe that TQM is best implemented when there is a strong foundation of QA to provide a pre-existing process for data collection and performance measurement. Using the eight-step model for implementing TQM adapted from Joint Commission standards and The Health Care Manager's Guide to Continuous Quality Improvement, the QA staff identified the customers of the QA department, their needs, and professional requirements; implemented changes to meet these needs; identified internal monitors to evaluate the effectiveness of the operational changes and monitor performance; reported results and identified opportunities for improvement; and problem solved with FOCUS-PDCA. These efforts yielded a customer satisfaction survey in the form of a report card. In addition, three case studies launched by the QA department to address abstract data accuracy and completion, nosocomial infection rates in cesarean-section patients, and receipt of hospital laboratory reports by peripheral clinics are described in detail. The NWAFH Program leadership believes that TQM is a pancultural concept and that these first successful efforts can provide a model for the expansion of TQM not only in Saudi Arabia but throughout the rest of the Middle East.

A Team Approach—Quality of Care in Special Care Units

Assistant Director of Nursing Practice and Quality Assurance Department of Critical Care Nursing The New York Hospital–Cornell Medical Center New York, New York

Monitoring the safety of transfusion practices in the U.S.

The public demands and deserves the safest blood products to be available when and where needed. Although absolute safety in the blood supply is a desirable goal, many intervening factors may have a bearing on its final quality. In the process of obtaining blood, the procedure for donor selection/exclusion acquires pivotal relevance. Then, once the blood product is taken to the processing laboratory, there is a need that tightly and narrowly defined parameters for component preparation, infectious disease testing, handling and storage be in place and strictly adhered to. Notwithstanding these measures to increase the safety and quality of blood, the most critical factor remaining in the whole operation is the one related to physician behavior and discipline as far as appropriate criteria for the use of blood products are concerned. Transfusion Medicine Physicians must keep a constant vigilance that the appropriate criteria for transfusion are utilized in 100% of cases. This, can only be achieved by an intense and continuous scrutiny and evaluation of every request for transfusions for every patient 24 hours a day, 7 days a week basis. This approach has allowed that we identify physicians who need help and understanding as to the appropriate use of blood products, as well as information about other equally effective options and alternatives. Misconceptions about whole blood, directed donations, unusual requests for fresh frozen plasma, without the documentation of abnormalities of the coagulation profile are rapidly intercepted and aborted. These unusual and unfounded requests are forwarded to the Department of Quality Assurance to further follow up and monitoring of physician behavior in this aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

The Textbook of Total Quality in Healthcare

PART I: HISTORY and OVERVIEW 1. Introduction and Historical Background The Early Days of Quality Assurance History of TQ in Manufacturing The Influence of Government on Quality in Healthcare Quality Assurance Departments Transitions 2. The United States Healthcare System and Quality of Care The First Two Hundred Fifty Years (1600-1850) The Next Hundred Years (1850-1950) 1950 to the 1990s PART II: PRINCIPLES, TOOLS, and TECHNIQUES of TOTAL QUALITY 3. Principles of Total Quality in Healthcare Organizations Selected Articles: Sounding Board: Continuous Improvement as an Ideal in Health Care The Case for Using Industrial Quality Management Science in Health Care Organizations Total Quality Management for Physicians: Translating the New Paradigm Organizationwide Quality Improvement in Health Care Articles Misconstrue Joint Commission's Position on Quality Improvement A New Look for Quality in Home Care 4. The Implementation of Total Quality Executive Level Commitment Transformation of the Culture Planning Quality Organizing Quality Evaluating Quality Selected Article: How to Start a Direct Patient Care Team 5. Data Management for Total Quality Transformation of Data to Information Data versus Information Data Reliability Data Validity Sensitivity and Specificity Data Collection, Display, and Analysis Tools for Identifying, Collecting, and Displaying Data Tools for Improving and Monitoring Quality PART III: TOTAL QUALITY ENVIRONMENT 6. Cost and Healthcare Quality Selected Article: Accounting for the Cost of Quality 7. The Law, Ethics, and Total Quality The Role of Laws and the Legal System The Role of Ethics The Interplay between Laws and Ethics Legislative Impetus Judicial Involvement in Determining Quality Ethics and the Elevation of Quality 8. Total Quality and Management Philosophies Organizational Cultures The Use of Power in Organizations TQ and Corporate Culture: Finding a Fit Transforming Organizations to a TQ Philosophy and Culture Managing the Process through Change PART IV: STRATEGIC DIRECTIONS 9. Integration of Total Quality and Quality Assurance Quality Assurance Activities in Healthcare Total Quality Transition to Total Quality: Manufacturing and Health Service Sectors Comparison of QA and TQ Integration of QA and TQ 10. Outcome Management and TQ Background of Quality Outcome What is Outcome and What is Outcome Management? Measurement of Outcomes Questions about Outcome Measurements Research on Outcome and Its Management Outcomes Management and Total Quality 11. Research and Total Quality Quality Management Terminology Background and Definitions Research-Based Practice Social Science Research Guidelines and Databases Research on TQ Instrumentation Research Epidemiological Studies Cost Studies Demonstration Projects Research Utilization Research Agenda PART V: CASE STUDY 12. Total Quality within the VA Healthcare System: A Case Study Annotated Bibliography Index

Development and evaluation of optical sensors for the detection of bacteria

The detection of actively metabolizing microorganisms is performed by many institutions, including medical and public health laboratories as well as quality-assurance departments in the food, cosmetic and pharmaceutical industries. Our objective is to develop a system with: (1) culture bottles containing growth media and sterilizable optical sensors and (2) an instrument that would automatically monitor bottles and evaluate each for evidence of bacterial growth. Carbon dioxide optical sensors have been chosen for the system, since CO 2 is recognized as a universal by-product of bacterial metabolism. Fluorimetric sensors, similar in principle to those described previously for measuring pCO 2 levels in blood, have been developed and optimized. An instrument (AVL BDS-240) has also been developed. The BDS-240 is a noninvasive automated system for the rapid detection of aerobic and anaerobic bacteria as well as some fungi. The instrument and bottle system are optimized to detect the presence of bacteria and fungi in fresh human blood (blood cultures). The instrument is capable of storing a total of 240 culture bottles. The bottles are arranged in six racks, each of which holds up to 40 bottles. Racks are continuously heated at 35 °C and are agitated for the maximum recovery of organisms. Samples are drawn from patients and injected directly into the culture bottles. The culture bottle is placed into a rack station. Each station has its own LED/photodiode optical unit. Every ten minutes LEDs (two racks at a time) illumiante the optical sensors in the bottles and photodetector measurements from each station are stored and evaluated for significant changes. Those bottles that indicate significant rate increases in CO 2 are flagged as positive. In recent clinical evaluation, five hospitals collected approximately 10 000 blood specimens in duplicate and inoculated each specimen into four bottles. Fifty percent of these bottles have been tested by the hospital's existing blood-culture method and the other 50% tested with the AVL BDS-240 system. The clinical trials lasted approximately eight months and the BDS-240 has been found to be equivalent to the hospital's current method with regard to the isolation of relevant microorganisms. However, because of the continuous monitoring capability, microorganisms are detected much faster by the BDS-240. In addition, the AVL system is much less labor intensive than the current methods of the hospitals.

LIMS and quality audits of a quality control laboratory

Conti, T.J., 1992. LIMS and quality audits of a quality control laboratory. Chemometrics and Intelligent Laboratory Systems: Laboratory Information Management, 17: 301–304. The discussion about the advantages and disadvantages of laboratory information management systems (LIMSs) began long before the first LIMS was ever installed. Even now, conclusions about the cost and benefits of a LIMS vary from laboratory to laboratory. In our organization, LIMS benefits and costs also have had mixed reviews. One area, however, where the benefits of a LIMS were initially underestimated, is the solid documentation for quality control efforts in the laboratory. This benefit manifests itself as a high level of customer satisfaction in the laboratory's ability to monitor, control and document its results. Before I discuss the laboratory information system that we use in Miles' Polyurethane Quality Assurance Department in New Martinsville, WV, I will provide some background about the operation.

Improving blood transfusion practice: role of a computerized hospital information system.

The recent focus on medical risk and financial cost has prompted a need for better guidelines for prescribing the transfusion of blood components. In 1987, to respond to the issues of quality transfusion practice and accurate evaluation, LDS Hospital (Salt Lake City, UT) began using a computerized, knowledge-based blood-ordering system. Each transfusion request was reviewed and flagged by the computer when it did not meet the criteria established by the medical staff. The study reviewed the use of red cells, platelets, and fresh-frozen plasma in 13,082 transfusion orders for 5847 consecutive patients from July 1, 1988, through June 30, 1989. The evaluation assessed, first, the adherence of physicians to computerized criteria and, second, their adherence to the quality of transfusion practice. A high percentage of the blood units ordered met the established criteria: 91.2 percent for the red cell transfusions, 72.9 percent for platelets, and 81.7 percent for fresh-frozen plasma. From the July 1, 1987, implementation date through June 1989, the mean hematocrit of persons being transfused dropped from 28.6 to 27.7 percent (0.29 = 0.28) (p less than 0.005) and the number of orders requiring review by the quality assurance department dropped from 100 to 14 percent; moreover, there was a true-exception rate of only 0.37 percent. The use of the computer system effected the implementation of the following measures: 1) identification of the indications and establishment of clear clinical and biologic parameters for every transfusion, and 2) measurement and improvement of institutional transfusion practice. These results demonstrated the efficacy of a computerized hospital information system in implementing continuous quality improvement for transfusion practice.(ABSTRACT TRUNCATED AT 250 WORDS)