The best definition I found on the Internet was at Hospital Quality Assurance Services, which describes a historical view of the hospital as whatever the doctor wanted to do he or she did, and whatever he ordered was completed by the medical staff, be it the nurse, respiratory therapist, x-ray tech, or lab tech. The doctors pretty much had the run of the mill per se.
Yet then came the day of the HMO and the Medicare, where third party insurance companies and the government were paying the majority of the bills.
Basically, it goes something like this:
" Traditionally, doctors have always enjoyed a great deal of freedom in their practices. Till some time back, the techniques for monitoring and assessing the quality of care they provided in the hospital were based on internal peer reviews. But with the growth of consumer awareness movements, public concern of health care priorities, governmental concerns about rocketing healthcare costs, new hospital accreditation guidelines and financial constraints of health institutions, hospital quality assurance has become compulsory for hospitals to project the quality of care, they provide."So it's the role of the quality assurance analyzer to make sure of the following (the following information obtained from http://www.careerplanner.com/ and virginia.gov/careerguides/hospitalQAanalyzer):
- Monitor data obtained from CMS Core Measures and record the data for review by both the CMS and the hospital's monthly Keystone Committee.
- To come up with ideas for improving performance on core values to improve patient outcomes and reduce costs.
- To consider relative costs and benefits of potential actions to choose the most appropriate one.
- Understanding written sentences and paragraphs in work related documents.
- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Talking to others to convey information effectively.
- Communicating effectively in writing as appropriate for the needs of the audience.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Using mathematics to solve problems.
- Identifying measures or indicators of system performance and the actions needed to improve or correct performance, relative to the goals of the system.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Using scientific rules and methods to solve problems.
- Interprets and implements quality assurance standards in hospital to ensure quality care to patients
- Reviews quality assurance standards
- Studies existing hospital policies and procedures
- Interviews hospital personnel and patients to evaluate effectiveness of quality assurance program.
- Writes quality assurance policies and procedures.
- Reviews and evaluates patients' medical records, applying quality assurance criteria.
- Selects specific topics for review, such as problem procedures, drugs, high volume cases, high risk cases, or other factors.
- Compiles statistical data and writes narrative reports summarizing quality assurance findings.
- May review patient records, applying utilization review criteria, to determine need for admission and continued stay in hospital.
- May oversee personnel engaged in quality assurance review of medical records.
They work with doctors, administrators, and other staffers at the hospital by organizing data, such as core measures, and to use that data in such a way as to improve performance at the hospital, and to reduce costs.
When by reviewing data they observe a problem, they notify the appropriate officials or department heads, who get to the bottom of the problem and then try to rectify it.
For example, it's the job of the Utilization Review Manager to double check charting to make sure charting is complete, protocols and order sets are complete, and that everything is complete in order to meet Intensity of Service (the patient was sick enough to be admitted) and Core Measures (every thing that needed to be ordered based on the most up-to-date wisdom was ordered for that patient).
If a problem is encountered that, it must be determined if this was an isolated problem, or if it is a problem that goes deeper.
For instance, when the core values were first monitored in 2007 at Shoreline Medical, smoking cessation orders were missed 70% of the time. This data was reported by the Quality Assurance Analyzer, and later brought up at a monthly Keystone meeting, where a plan was set in place to improve in this area.
Now smoking cessations are completed and charted accurately nearly 100% of the time.
Another problem back in 2007 was it was discovered via studies that pneumonia patients who received a flu vaccine and pneumococcal vaccine were less likely to get secondary pneumonia and return to the hospital. This this was made into a core measure.
Back in 2007 only 70% of patients received these vaccines. In 2010 nearly 100% of pneumonia patients receive these vaccines.
So you can see, it's the job of the quality assurance analyzer to analyze this data and to come up with idea, and to work with others in the hospital, to solve problems. The entire purpose of this position is to benefit the patient. If the patient is being treated properly, then the cost to the hospital, the government, and private insurance companies would be less.
Now, instead of doctors running the show, protocols, order sets, and improved clinical pathways make sure that certain procedures are automatically performed once a patient is diagnosed with a particular diagnosis (DRG), especially when studies show these procedures are known to improve patient outcomes.
For example, when a patient comes to the ER with chest pain, he automatically has to have an EKG completed within 10 minutes. If the patient is admitted and diagnosed with chest pain observation, the patient automatically has an EKG ordered ever two hours times six hours, then every morning for the next two days.
He will also automatically be ordered on oxygen, and have a stress test ordered for the next day. These are all automatic because they are proven to improve patient outcomes.
Total Quality Assurance Services notes that, "The success of all hospital quality programs depend on the interest and commitment of the administrators, physicians, nurses and paramedical staff. A lack of interest is far more damaging than any technical error in the evaluative process. Thus coordinators of hospital quality assurance courses must select strategies that evoke interest and commitment and does not burden the staff with activities they do not believe in."
So quality assurance monitoring is essential to reviewing data, improving quality of services provided, and communicating new ideas for continued improvement.
Likewise, "Hospital quality assurance activities extend beyond the usual sources of information like medical charts or service records. With additional sources – like resource allocation, rates of utilization and results of consumer surveys that provide insight into the broader dimensions of medical care, it is possible to enhance the value of these quality programs."
Making sure core measures and Intensity of service is met may often result in order sets and protocols that generally seem to throw everything we have at the patient in order to make sure we cover our bases, all with the idea that we want to make sure we are reimbursed.
It's complicated, maybe even frustrating, yet necessary. Yet with continued involvement and input from RTs and RNs, the end result of improved clinical pathways should result in protocols that allow the RTs and RNs to do what works as opposed to what does not work.
Yet while the transition is made, there may be some unnecessary throw ins, such as breathing treatments on every patient admitted for pneumonia, IVs on every patient admitted to the emergency room while this wouldn't be needed if you went to the doctor's office, and lab draws on every patient.
The role of the QA analyzer is not to make life more miserable and to cause us RTs to become burned out. However it may seem that way at times. Some of us RTs and RNs may think these analyzers are more concerned with paying the bills than taking care of patients.
Yet the ultimate goal is to improve outcomes and lower costs. So by working with your quality assurance analyzer or manager, you may be able to determine the statistics to justify the changes you have for improving your departmental services.
For more information about quality assurance check out this link.