Formatting and presenting quality data to medical staffs and hospital boards.

Shortly after the turn of the century, Ernest Codman, MD, first challenged Massachusetts General Hospital to demonstrate that patients entering the institution were receiving high-quality medical care. He publicly challenged the hospital's board of directors to require appropriate review of medical records and of patient follow-up, posing the use of the "end result card" to ensure that the care rendered was of high quality.

As a reward for his advice, he was asked to resign his position in the Suffolk District Medical Society, and, for some time, he was considered a medical "outcast." Fortunately, he did not waver and, ultimately, became a founding member of the American College of Surgeons and, indirectly, a driving force in the formation of what is now the Joint Commission for Accreditation of Healthcare Organizations (JCAHO).

Since the founding of JCAHO, there have been almost constant changes in methods to ensure that health care organizations render high-quality health care to their patients. For many years, the prevailing attitude of many hospitals and their medical staffs was to simply state that the care rendered in their institutions was of good quality. Because of demands of corporate America, as well as of government, that attitude has changed, and institutions must now prove that the care rendered their patients is of good quality.

Over the past several years, hospitals have witnessed an ever-changing format from the JCAHO. The prescribed quality format has moved from audits to the five-step QA method, to the 10-step QA method, to outcomes, to TQM/CQI, and now to performance standards.

Institutions have struggled to perfect methods that demonstrate that these standards are met. Many JCAHO standards are broad and at times vague, with few "how to" instructions on implementation.

It has become increasingly clear that any method used to prove that overall high quality of care is being rendered must be data based. This in no way removes the necessity of individual medical record reviews for sentinel events. These events, which may be either institutional or practitioner in origin, must be performed for reasons of risk management.

Computer hardware that allows reasonable data collection is readily available. Unfortunately, comparable software is lacking, as are methods for handling databases in a manner that can ensure timely analysis, easy formatting, and simplified methods of presentation for review, education, and instruction. We have perfected a method to assimilate, format, and present data to hospital personnel, medical staff, and a lay board of directors while maintaining confidentiality. Use of an "executive session" by a lay board to receive quality data presentations can ensure confidentiality and limit discoverability.

Our past presentations involved a complex process of producing overhead transparencies. Generally, each slide of a presentation was generated by a desktop computer in black and white using a dot matrix or laser printer. Often these presentations were ineffective, boring, and time-consuming to produce. If information was updated or changed, the transparency had to be reproduced to maintain data integrity. QA/CQI reporting requirements necessitated a more efficient approach to our presentation.

Three recently developed hardware devices have changed the method of our data presentations. The color laptop computer, the liquid crystal display (LCD) panel, and the handheld remote control unit have allowed us to present high-impact and informative presentations. These items, combined with the traditional overhead projector, are used for presentations of quality data to the medical staff and the board of directors. The data can be presented without creating a hard copy, thus ensuring confidentiality. If desired, a hard copy can be created for future review by a state licensure board or JCAHO.

The IBM ThinkPad[R] 700C notebook computer provided the elements required to fully implement this system. This portable computer has a 486SLC, 25MHz microprocessor and a 10.4-inch diagonal active matrix color display. Integrated in the unit is a Video Graphics Array (VGA) display port for attaching the LCD panel. This allows viewing on the computer's monitor display while outputting to the externally connected panel. The computer's built-in serial port is necessary to attach the remote control unit used in our presentations.

Realizing that our medical staff, hospital staff, and board of directors could interpret vivid color graphics much easier than black and white overheads, we used a 3M Projection Panel Model 5300, with a true color active matrix liquid crystal display. This unit features improved color display capabilities when compared to older units with a black and white or passive matrix color display. The color from passive matrix panels is dull and pale and is inferior to active matrix LCDs for high-quality presentations. The remote control used in our presentations is also a 3M product. The unit is shipped with Panel Ready[R] software to add remote control capabilities to a variety of LCD panels. The remote control system consists of two hardware components: a wired receiver attached to the computer's serial port and a handheld transmitter housing pushbuttons to duplicate certain computer keystrokes. Once connected, the LCD panel rests on top of an overhead projector. The projector must have the light source in the base (transmissive) and not in the upper lens housing (reflective). The brighter the light source in the projector, the better the projected panel image. The projector should also provide for edge-to-edge sharpness when used in conjunction with the chosen panel. (Several manufactures are currently marketing projectors specific for LCD panel applications.) Once complete, this method of presentation removes all attention from the hardware components and allows the audience and presenter to focus on the presentation.

If documentation is desired, the computer screens can be printed directly from the laptop computer, either in black and white or color images. We prepare hard copies of the slide images on an IBM Colorjet PS 4079 printer for review purposes by state licensure and JCAHO surveyors (see figures 1-3, pages 20-21).

Our presentation method has been tested for acceptance and accuracy and can be easily reproduced. It has received glowing comments from audiences. Not only are the quality and the clarity of our presentations greatly enhanced, but confidentiality is relatively easy to ensure.