Going beyond Right and Wrong: Building the Framework for Quality Improvement in Congenital Echocardiography—You Can't Manage What You Don't Measure

Autor: Brian D. Soriano, J. Geoffrey Stevenson, Kenneth Rudberg
Rok vydání: 2014
Předmět:
Zdroj: Journal of the American Society of Echocardiography. 27:624-626
ISSN: 0894-7317
DOI: 10.1016/j.echo.2014.04.007
Popis: At an early morning hour at the start of a busy work day, a dozen individuals position themselves at conference room tables in front of a projector and screen. After the lights dim, a series of scenarios are presented, each one selected to review a diagnostic error. In the ensuing discussion, the group attempts to identify root causes. For those who had been directly involved in the error, personal feelings are set aside with the recognition that a dispassionate evaluation is the best means for identification and prevention of future errors. A nonblameful conference environment allows free discussion, leading to the formulation of an action plan. This type of conference likely takes place in many industries, whether it be manufacturing, aerospace, or health care. In clinical cardiology, the same kind of multidisciplinary approach is increasingly being used to assess and address diagnostic errors in echocardiography. The goal is to improve patient care. In this issue of JASE, Benavidez et al. 1 strive to better define the sources of diagnostic errors in congenital echocardiography, while at the same time inserting examples and suggesting strategies to mitigate error risks. Their work highlights and acknowledges a new focus in 21st-century medicine. In clinical echocardiography, we may know how to do it. 2 The next questions form the crux of Benavidez et al.’s present work: How well are we doing it? 3 How do we manage error risks if we don’t measure them? How dowe integrate these important goals within the quality domain, recognizing that additional resources will be required for effective implementation? Like health care itself, the concept of quality is evolving. The Institute ofMedicine,anarmofthe NationalAcademyof Sciences,listssix quality dimensions: safety, effectiveness, timeliness, equity, efficiency, and patient-centeredness. 4 We hear of ‘‘quality assurance’’ activities, implying that achievement of a preset standard represents ‘‘quality.’’ Once achieved, the process need go no further. Those words have been frequently replaced by the phrase ‘‘quality improvement’’ or the more explicit ‘‘continuous quality improvement.’’ The evolving phrase becomes its own illustration that just like any biologic system, a standard, an established process, or a condition is ephemeral. Ensuring quality demands meticulous attention and ongoing awareness of situations and resources. Success requires both the realization that however good a quality assurance process or echocardiogram may seem to be, it can always be better, and that the review process be free of blame or retaliation. Quality improvement initiatives involve not just the echocardiography laboratory but also extend broadly throughout other arenas, such as health care administration and physician and sonographer credentialing. In 2000, the American Board of Medical Specialties, composed of 24 different specialty boards, including pediatrics and internal medicine, chose to shift the idea of physician credentialing from recertification to the trademarked ‘‘maintenance of certification.’’ Even in the face of controversy, maintenance of certification has become an expected activity for those wishing to remain board certified. For both pediatrics and internal medicine, ongoing certification is now predicated on successfully completing activities that are considered to be important in quality improvement. More recently, the self-rebranded Intersocietal Accreditation Commission, formerly called the Intersocietal Commission for the Accreditation of Echocardiography Laboratories, created guidelines to incorporate quality improvement measures in echocardiography laboratories. 5 To come full circle, at the time of this writing, the commission offered its own program for pediatric cardiologists to accrue maintenance-ofcertification credit. 6 The mission and directives of creating quality improvement metrics are taking form, but questions remain. What metrics do we measure, and how do we measure them? Cardiologists have the opportunity to have a direct impact on what parameters should be tracked and assessed, while at the same time receiving credit toward certification.
Databáze: OpenAIRE
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