Unit Accreditation Research Articles

A new composite measure of colonoscopy: the Performance Indicator of Colonic Intubation (PICI).

Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. METHODS : Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 - 3/5. Multivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. RESULTS : PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years' experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. CONCLUSIONS : PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives.

Incorporation of Interprofessional Education in Nutrition and Dietetics Education Programs

Many health professions incorporate interprofessional education (IPE) to prepare graduates for collaborative practice, although little is known about IPE implementation in nutrition and dietetics (ND) education. The purpose of this study was to evaluate IPE integration in ND programs and identify institutional factors impacting IPE availability and participation. One hundred sixty-seven directors of accredited ND programs responded to an electronic survey using the Interprofessional Education Assessment and Planning Instrument for Academic Institutions. Results showed that ND programs are incorporating IPE on a minimal basis and many institutional factors affect IPE participation, including academic unit and program accreditation type.

Toxicology Training Unit in Emergency Department Reduces Admission to other Specialties and Hospital Length of Stay

Objective To evaluate the outcome of intoxicated patients presented to Accident and Emergency Department (AED) in Hong Kong with Toxicology Training Unit accreditation and AED without toxicology team. Method A retrospective observational study with data collection from all intoxicated cases reported through Pre-hospital Activated Charcoal Programme, a protocol driven poisoning reporting system, from 1/7/2011 to 30/6/2013 (2 years). Data on basic demographic data (e.g. sex, age), receiving AED, admission rate to other specialty, length of stay in hospital exclude psychiatry ward admission and clinical outcome were collected and analysed. Five AEDs with Toxicology Training Unit (study group) and 7 AEDs without toxicology team (control group) were included. Results A total of 329 intoxicated cases were included in this study. The basic epidemiological data were similar in both groups. There was a significantly lower in hospital admissions in study group (16.9%) than in control group (69.3%; p<0.001) and significant shorter median of hospital stay of 22.1 hours (interquartile range [IQR] 12.8-43.5 hours) in study group compare to 42.7 hours (IQR 20.4-76.1 hours) in control group (p<0.001). Conclusion Our findings show that the establishment of the toxicology training unit can achieve significant reduction in admissions to other specialty and the length of stay in hospital in the management of patients with acute intoxication.

Quality Assurance in Gynecologic Ultrasonography [393

INTRODUCTION: A quality assurance program is required for ultrasound unit accreditation, although the specifics for such a program are not defined. There is no known benchmark for accuracy of ultrasound diagnosis to which a unit may compare its results. This study describes one unit's quality assurance and quality initiative program for gynecologic ultrasonography designed to meet accreditation requirements as well as a means to improve the accuracy and performance of gynecologic ultrasonograms. METHODS: All emergent and elective gynecologic surgeries from October 2010 to December 2013 were reviewed. Patients included in our study had a formal ultrasound examination in our American Institute of Ultrasound in Medicine–accredited department within the 12 months preceding their surgery. The ultrasound diagnoses were compared against the final pathology results for accuracy. All images from case discrepancies were reviewed on a regular ongoing basis by interpreting physicians and ultrasonographers. RESULTS: There were 453 patients who had a gynecologic ultrasonogram and within the next 12 months underwent surgery during the study time period. During the study period, our unit showed an 83.0% rate of diagnostic and pathologic match for major findings. After instituting this review process, our accuracy improved from 79% in 2010 to 90% in 2013. CONCLUSION: We have described one method for conducting ultrasound quality review and have shared our unit's accuracy of diagnosis. We hope that this abstract will lead to further data-sharing and discussion, because there are no previous studies describing comparative ultrasound accuracy rates nor are there any proposed national guidelines for quality assurance programs in ultrasonography.

2068948 Quality Assurance In Gynecologic Ultrasound

Objectives: A quality assurance program is required for ultrasound unit accreditation, although the specifics for such a program are not defined. There is no known comparative benchmark for the accuracyofultrasounddiagnosis.This studydescribes one unit’s QA/QI program for gynecologic ultrasound designed both to meet accreditation requirements as well as to improve the accuracy and performance of gynecologic ultrasounds. Methods: All emergent and elective gynecologic surgeries from October 2010-December 2013 were reviewed. Patients included in our study had a formal ultrasound in our AIUM accredited department within the 12 months preceding their surgery. The ultrasound diagnoses were compared against the surgical pathology results. Amajor site match was defined as concordance between the suspected pathology seen on ultrasound that prompted surgery and final pathology. All additional pathology found intraoperatively, called secondary pathology, was also included in the review. Images from case discrepancies were reviewed regularly by interpreting physicians together with sonographers. After review, improvement recommendations and changes in practice were made. Results: There were 453 patients who had a gynecologic ultrasound and underwent surgery within the following 12 months between October 2010 and December 2013. During the study period, our unit showed an 83.0% rate of diagnostic and pathologic match for major findings. For secondary pathology, 589 results were reviewed and our unit demonstrated a 77% match rate. After instituting this review process, our accuracy of diagnosis improved from 79% in 2010 to 90% in 2013 for major site matches. Conclusions: We have described one method for conducting quality review and have shared our unit’s accuracy of diagnosis. There have been no previous studies describing an ultrasound unit’s accuracy to use for comparison, nor any recommendations on how to best conduct quality review. We hope that this will lead to further data sharing and discussion of the ultrasound QA/QI process. By opening the discussion on accuracy of gynecologic ultrasound as judged by an institution or unit, comparisons could be made to optimize safe and accurate use of ultrasound technology in the care of women.

PWE-057 A Composite Measure Of Colonic Intubation (circ) Is Better Able To Distinguish Performance Of Colonoscopy And Is Associated With Higher Polyp Detection Rates

IntroductionCaecal intubation rate (CIR) is a key performance indicator of colonoscopy. CIR with acceptable tolerance is only achieved in some patients with more sedation. As most colonoscopists achieve >90% intubation,...

Quality improvement of gastrointestinal endoscopy in Korea: past, present, and future

The motivation for improving quality of gastrointestinal endoscopy begins with the desire to provide patients with the best possible care. Gastrointestinal endoscopy is an excellent area for quality improvement because of its high volume, significant associated risk and expense, and variability in its performance affecting outcomes. Therefore, the assurance that high-quality endoscopic procedures are performed has taken increased importance. The 'Korean Gastrointestinal Endoscopy Research Foundation' and 'Korean Society of Gastrointestinal Endoscopy', as ladders in promoting the highest quality patient care, formed endoscopy quality evaluation in 'National Cancer Screening Program' and'Endoscopy Unit Accreditation' in Korea. However, both new systems have not settled down despite efforts of many years and support by the government. In this article, the past and present of quality improvement of gastrointestinal endoscopy will be reviewed, and the future of quality improvement of gastrointestinal endoscopy will be illuminated.

Indicadores de calidad en cáncer de mama

Quality indicators in breast cancer surgery Introduction: Although clear guidelines for breast cancer management have been developed and wi- despread, there are many variations between centers and even among breast cancer surgeons, with impact in clinical outcomes. Use of quality indicators to assess surgical care allows comparison with standards and with other centers and monitoring changes post intervention. Objective: To apply quality indicators to breast cancer surgery and evaluate usefulness. Material and Methods: Selected indicators obtained from EUSOMA 2008 workshop were applied to 213 consecutive surgical treatment breast cancer patients from Hospital Militar de Santiago de Chile between 2006 and 2011, comparing results with previously defined standards. Results: Benign/malignant index in surgical biopsies: 1: 2.27 (minimum standard: 1/2; Optimum: 1/4), patients with complete pathologic report percentage: 99,2% (minimum: 95%, optimum: 98%), breast conserving surgery percentage: 80.20% (minimum: 70%, optimum: 80%), patients with sufficient axillary sampling percentage: 92.4% (minimum: 95%, optimum: 98%), correct axillary dissection indication per- centage: 100% (minimum: 95%, optimum: 98%) and patients who underwent single surgery percentage: 90.40% (minimum: 80%, optimum: 90%), most of them ranged between established standards. Conclusion: The use of quality indicators allows breast cancer surgery result evaluation, enabling comparison between centers and established standards, giving objective and reproducible information, helpful to plan process optimization. These or similar indicators are useful in all breast cancer treatment steps and for breast cancer unit accreditation processes. Our indicator values that are under the standard reveal that some specific local indicators are required.

Quality Indicators in Breast Cancer Surgery

INTRODUCTION: Although clear guidelines for breast cancer management have been developed and widespread, there are many variations between centers and even among breast cancer surgeons, with impact in clinical outcomes. Use of quality indicators to assess surgical care allows comparison with standards and with other centers and monitoring changes post intervention. OBJECTIVE: To apply quality indicators to breast cancer surgery and evaluate usefulness. MATERIAL AND METHODS: Selected indicators obtained from EUSOMA 2008 workshop were applied to 100 consecutive surgical treatment breast cancer patients from Hospital Militar de Santiago de Chile between 2009 and 2011, comparing results with previously defined standards. RESULTS: Benign/malignant index in surgical biopsies: 1 / 2,93 (minimum standard: 1 /2; Optimum: 1/ 4), patients with complete pathologic report percentage 100% (minimum: 95%, optimum: 98%), breast conserving surgery percentage: 68,42% (minimum: 70%, optimum: 80%), patients with sufficient axillary sampling percentage: 100% (minimum: 95%, optimum: 98%), correct axillary dissection indication percentage: 100% (minimum: 95%, optimum: 98%) and patients who underwent single surgery percentage: 88,2% (minimum:80%, optimum: 90%), most of them ranged between established standards. CONCLUSION: The use of quality indicators allows breast cancer surgery result evaluation, enabling comparison between centers and established standards, giving objective and reproducible information, helpful to plan process optimization. These or similar indicators are useful in all breast cancer treatment steps and for breast cancer unit accreditation processes. Our indicator values that are under the standard reveal that some specific local indicators are required.

Using Portfolios to Fulfill ISTE/NCATE Technology Requirements for Preservice Teacher Candidates

The International Society for Technology in Education (ISTE) has developed computer/technology guidelines for all teachers. These were approved by the National Council for Accreditation of Teacher Education (NCATE) as a part of the requirements for those seeking teacher certification in computer literacy, computer science education, and those seeking MA degrees in educational computing and technology. In addition, NCATE's new Unit Accreditation guidelines require integration of technology into teacher education programs. For most teacher education programs, these gUidelines are welcome and will serve as a catalyst for preparing teacher candidates to be technologically competent. However, many teacher education programs cannot add additional courses to their curriculum. One way to overcome this obstacle is to require the infusion of technology across the teacher education curriculum and use portfolios to evaluate the success of teacher candidates in fulfilling the ISTE/NCATE guidelines. This article describes the successful implementation of a technology portfolio process and suggests activities to include in such a portfolio.

Integrating services to improve patient care

Over the past few years there has been an increasing need to reconfigure emergency care service delivery so that patients can be seen and treated as quickly as possible by the right person in the right place at the right time. This reconfiguration requires changes in culture and working practices, and the bringing together of previously disparate services. This article describes how the integration of three distinct but co-located emergency services at Poole Hospital NHS Foundation Trust was initiated through the process of practice development unit accreditation.

Expanding the breast unit accreditation process to ensure standardisation of best care for all women across Europe

Expanding the breast unit accreditation process to ensure standardisation of best care for all women across Europe

The practice development accreditation programme at the University of Leeds

AbstractThe practice development unit accreditation programme offered by the Centre for the Development of Health Care Policy and Practice (CDHPP) at the University of Leeds is now more than 10 years old. Since its inception more than 100 units have been accredited. A high proportion of these units have chosen to stay with the programme, and there are currently approximately 75 active units throughout the UK. There are also 11 units in the Republic of Ireland and four in the USA. Units have been accredited in most specialties ranging from intensive care units in acute hospitals to community residential mental health services. Services from the NHS, voluntary sector and private facilities have been accredited, and more recently a team of education providers has joined the programme. As far as is known, the programme offered by CDHPP is the largest such accreditation programme in the UK, and units continue to join. The programme clearly helps participating units to meet the demands and changes required by the NHS modernization agenda, and so it appears to be as relevant to practitioners as it ever was. It is therefore timely to examine the programme in some detail. Copyright © 2004 Whurr Publishers Ltd.

Evaluating the scope for nursery nurses to perform selected 21-month child health reviews

Warrington Primary Care Trust health visiting team has recently achieved practice development unit accreditation. The journey towards this status has harnessed the enthusiasm and dedication of the whole team, which has worked on numerous projects to achieve accreditation at level 2 in a year. The 21-month nursery nurse pilot study described here focused on the expansion of the role of nursery nurses to enable them to deliver a client-focused service that made the most effective use of the skills and time of both nursery nurses and health visitors. The project also contributed towards the achievement of practice development unit status. Copyright © 2003 Whurr Publishers Ltd.

The challenge of practice development unit accreditation within an elective orthopaedic ward

This article describes the background and the process of an elective orthopaedic ward being accredited as an orthopaedic Practice Development Unit. It explains the strategies used to gain the accreditation, the problems encountered and the achievements of the multi-disciplinary team. The article demonstrates that accreditation is the start of future developments.

Unit accreditation: A response to a curriculum and assessment need

Unit accreditation: A response to a curriculum and assessment need