OBJECTIVE: To determine whether adverse occurrence screening of inpatient discharge summaries by means of a limited number of criteria can provide an effective medical quality control system without requiring substantial additional resources. DESIGN: The medical records department used 14 criteria to screen all inpatient discharge summaries shortly after discharge. Summaries ...

Computing systems for quality assessment in the operative departments, in anaesthesia and intensive care were developed at the Altona General Hospital, Hamburg. The main goals were to support quality assurance as a tool for the medical staff which they can use actively in their routine work and to reorganize uneconomical ...

The choice of the correct material for medical syringes is determined by the requirements demanded by users and manufacturers. New advances are making it easier to meet these requirements and leading to higher quality products with increased reliability. In this article, the author looks at the requirements of a good ...

The historical development of price indexes as wage adjustment mechanisms is reviewed, as is the theory of aggregation and methods for dealing with quality and technological change. The construction of the U.S. Bureau of Labor Statistics (BLS) Medical Care Price Index (MCPI) is detailed. ARIMA analysis of the MCPI for ...

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators ...

In 1987, Ellen Gaucher took an unusual trip. As senior associate director of the University of Michigan's sprawling 11,000-employee Medical Center, she was invited to a conference about a movement that was rapidly growing in the word of business--total quality. The occasion was the organizational conference of the National Demonstration ...

In 1991 the third of a series of trials of concurrent case note screening was conducted over a 4 month period in one surgical and one medical unit of a busy metropolitan public teaching hospital in South Australia. The conclusion reached was that there is insufficient evidence of consistent improvement ...

In summary, quality assurance in medicine and in CVIR must be an important part of daily practice. The JCAHO is gradually moving toward quality improvement as a goal, rather than simply monitoring performance. Physicians must lead the way in dealing with the issues of monitoring performance, with the ultimate goal ...

To determine the characteristics and effects of quality assurance programs in emergency medical service (EMS) systems in Michigan, medical directors of all EMS medical control authorities in Michigan were mailed a survey consisting of 14 closed-ended and open-ended questions including 2 using a subjective continuum scale; the study included phone ...

These few subjects are only a small fragment of the scope of pediatric medicine but are critical in their impact. The depth of material needed to cover the subject adequately should fill a textbook. If, however, aviculturists could master these seven areas, the numbers of babies requiring medical or surgical ...

A system is described that improves the quality of medication cart filling, increases the speed and quality of medication cart checking, and decreases omissions or incorrect dosage errors in medication administration. In a system where scheduled medications and PRN medications are kept in separate drawers, all of the patients' oral ...

Even though much of the quality-assurance process had been automated at Kettering Medical Center (KMC) in Dayton, Ohio, reviewers still had to key in data from paper records each day. An extensive paper trail continued until Kettering took the leap to total paperless review using eight laptop computers with internal ...

Endotracheal intubation is a critical skill necessary in a number of situations encountered by air medical personnel. The purpose of this study was to establish a threshold for the quality assurance indicator of successful tracheal intubation in a physician-staffed air medical system. The records of all patients transported by a ...

The American Medical Association's long-standing commitment to improving the quality of medical care has been marked by a variety of efforts, from improvement of medical education and accreditation to technology assessment and peer review. But with increasing nationwide attention on evaluating quality of care, the AMA, as well as many ...

This study is unique in that it involved the efforts of several professional groups at eight medical centers to solve a common quality assurance problem. The study used a systematic approach to evaluate and improve the quality of care provided to veterans transferred from one facility to another. The initial ...

Good results have been achieved in the treatment of patients with burns with new splinting materials and proper splinting techniques. This article focuses on the thermoplastic splinting materials Clinic and Spectrum (Northcoast Medical Inc., San Jose, Calif.) and the comparable thermoplastic products Polyform (Smith & Nephew Rolyan, Inc., Menomonee Falls, ...

This article presents a method that is helpful in achieving compliance with the JCAHO medical staff monitoring standards. Since the QA activity of the medical staff is of great importance to the institution, it is imperative that monitoring activities are clearly documented and easily evaluated. Through the use of a ...

This chapter emphasizes spirometry guidelines for conducting medical surveillance and epidemiological studies beyond those addressed by the 1987 American Thoracic Society Spirometry Update. These guidelines include specific recommendations concerning testing equipment, test performance, quality control, and technician training. Use of these guidelines should help ensure that changes in lung function ...

PREOP is a prototype expert system that is designed to provide physicians with evidence-based recommendations concerning the assessment and care of patients with comorbid medical problems who are about to undergo surgery. The knowledgebase for this system is currently undergoing transition from the conventional advice of medical experts, which is ...

Attitude studies of patients, their relatives, and sometimes even widows or widowers suggest that about 80 per cent of a small sample of Swedish in-patients are satisfied. However, the discontinuity of patient-staff relations in 69 per cent of out-patients is disturbing. There is a possibility that medical quality in the ...

A medical director has enormous influence on medical cost and quality in managed care organizations. Little empirical work has been done on the attributes of an effective HMO medical director. The survey discussed in this article sought to examine those desirable traits from the perspective of medical directors who have ...

Medical teachers usually do not have ready access to a resource for obtaining good quality illustrations for routine instructional activities and, at times, even for presentation of research findings in publications or at seminars. The inadequacy is especially apparent when human figures or objects need to be shown indicating depth ...

Part I of this article explored flaws in the operation of peer review in the selection of articles for journal publication and decision-making in the award of research grants, and Part II described medical peer review, its practitioners, and the distinctions between medical peer review and other activities and processes ...

The first part of this article explored the flaws in the operation of peer review in two contexts: selection of articles for journal publication and decision-making in the award of research grants. There it was suggested that, to the extent these flaws had adverse effects on the information available to ...

As hospitals increasingly emphasize efforts to measure and improve quality of care, the related issue of severity measurement emerges as a topic of strong interest. Severity measures can support hospital quality management in at least two areas: selection of medical records for individual case review and monitoring of patterns of ...

The relationship between quality of life (QOL) and alexithymia was examined in dialysis patients. Hemodialysis (HD) patients with diabetic nephropathy had poor QOL in medical dimension. Although they had good QOL in psychological and social dimensions, a high prevalence of alexithymia associated with self-control ability was observed. These results suggest ...

A significant number of workers suffer a variety of physical symptoms and illnesses associated with poor indoor air quality. These authors furnish employers with a guide for providing clean air in the workplace--an objective the achievement of which will reduce employee absenteeism and medical insurance costs, while increasing productivity and ...

The implementation of quality assurance monitoring is an important response to public demands for accountability in medicine as well as a requirement for institutional accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The author examines the somewhat elusive definition of quality as it is applied to medical ...

With the support and guidance of the medical staff, a protocol for IV theophylline dosing and monitoring has been implemented. The patients' theophylline needs are individually determined by pharmacists using clinical criteria and historical data determined for each patient. Ongoing monitoring and dosage adjustments are provided. The protocol is described ...

The Operative Registry, also known as DA Form 4108, constitutes the basic, geographically focused, sequential log of operative activities for any given Army Medical Treatment Facility. The information provided for the Registry, with specific refinements, constitutes an essential data base for quality assurance and utilization review. The experience at Madigan ...

Since implementation of Medicare's prospective payment system, the emphasis of medical peer review organization (PRO) activities is quality health care in the appropriate setting. The Texas Medical Foundation's dedication to quality health care is evident in its quality review, in its information to the medical community, and in its challenges ...

In the course of a quality assurance (QA) activity on the use of antimicrobics the authors set out to assess the management of urinary tract infection (UTI) in 76 patients. From culture data they noted an excellent or correct use in 78% of the patients, but a misuse in 22%. ...

The Biomedical Engineering Department (BME) at the University Medical Center, Tucson, Arizona, noted a sharp increase in the use of rented medical equipment. To increase efficiency, control costs, and provide effective quality assurance for rented equipment, a Medical Equipment Rental Vendor (MERV) program was formulated. The program increases efficiency by ...

The goal of quality assurance is to guarantee quality in medical care through the detection of problems with their subsequent evaluation and study, and through the implementation of corrective measures, when necessary. This article describes the criteria, methods, and results of a programme of quality assurance introduced in the Hospital ...

A comparison has been carried out of results of cerebral and spinal-cord angiography with two non-ionic contrast media, iohexol and Iopamiron, and a low-osmolality contrast medium, Hexabrix. A comparative study of iohexol, Hexabrix, and Iopamiron was carried out in a first group of 41 patients, and Hexabrix was compared with ...

A method for the identification, documentation, and resolution of problems related to missing medications is described. In cooperation with nursing, a procedure for dispensing doses needed using a medication request form was implemented. Medications are not dispensed without a written request. This has made it possible to enumerate, quantify, and ...

Withholding or withdrawing life-sustaining treatment when death is not imminent goes beyond the issue of whether or not medical interventions are simply prolonging dying. It treads on the slippery slope of quality of life judgments. Courts, in keeping with a tradition of self-determination, continue to protect a patient's right to ...

Two presentations given at the AMRA Annual Meeting in Denver received high praise from participants for the way in which they addressed physician-related quality assurance issues. Some of the material developed by Sue King, CMSC, who spoke on "Physician Credentialing Systems," and by William Jessee, MD, who gave a presentation ...

Self-care, though the most common of all forms of therapeutic action, has been little studied. This paper describes the context of self-medication with western pharmaceuticals in an area of South Cameroon (in 1980). The identity and appropriateness of these pharmaceuticals are briefly discussed. The paradoxical character of self-medication is emphasised: ...

On a very basic level, those who study suicide are either explicitly or implicitly concerned with the certification of suicide deaths by coroners and medical examiners. Although many authors have questioned the reliability and validity of officially reported rates, these statistics continue to be quoted as fact--a potentially problematic practice ...

In the rush to diversify, many hospitals are not seriously evaluating the various opportunities open to them. This article will focus on the efforts at Swedish Medical Center, Englewood, Colorado, to couple areas of expertise with market responsiveness. The end result, Swedish Wellness Systems, is a high quality health promotion ...

There is no technical language with which to speak of patients' quality of life, there are no standard measures and no authority to validate criteria of measurement. It is well known that 'professionals' tend, often for institutional reasons, to play down or undervalue factors which are not defined by their ...

As of 1980, approximately 1,800,000 people reached the age of 65 each year in the United States. It may be estimated that each year 35,000 of these people would benefit from total hip replacement surgery and are medically fit for it. Numbers for knee replacement are similar. Other joint replacements ...

The remotely controlled on-line production with a cyclotron of 15O2 and C15O2 for routine medical use is described. The radiochemical purities have been determined and compared with literature data. The impurities formed during irradiation can be removed with appropriate traps. The toxic gases ozone, nitrogen dioxide and carbon monoxide are ...

Having patterned the character of Sherlock Holmes after one of his professors, Sir Arthur Conan Doyle, himself a physician, incorporated many of the didactic qualities of the 19th century medical diagnostician into the character of Holmes. In this paper I explore Holmes's techniques of deductive reasoning and their basis in ...

Medical psychotherapy is often practiced by family physicians unknowingly. It shares certain features with all other forms of psychotherapy, but it also possesses its own unique qualities. Medical psychotherapy represents combinations of techniques, learned largely by experience, that are useful in treating the patient in crisis, as well as the ...

Whether existing equipment is modified for use in mammography or a dedicated system is purchased, the services of a qualified medical physicist are necessary. Factors to consider in modifying existing equipment and in purchasing new equipment are detailed, as well as features concerning patient safety. Guidelines for quality assurance tests ...

Quality assurance activities are no longer merely a luxury of the research-minded group practice. They have become essential in the face of today's federal laws, accreditation requirements, and competitive market. The authors examine the traditional lack of enthusiasm for quality assurance programs (QAPs) and seek to determine how the ambulatory ...

Because of its very nature, cytopathology has not lent itself well to quality control. At the University of North Carolina, we practice an internal quality control system based on peer review, interprofessional dialogue and utilization of follow-up information. Recently reported cytology specimens are rescreened and correlated with related surgical specimens. ...

Quality circles are a new phenomenon in American industry. Can the touted virtues of quality circles-improved morale, productivity, and product quality-be translated into the health care setting? In some departments, probably. But it remains to be seen if medical staff members will become major supporters of the quality circles movement. ...