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Is quality control quality assurance?

Is quality control quality assurance? Laboratories have always considered quality control techniques to be the basis for assuring quality results. This is a process-oriented approach, concerned mainly with activities within the laboratory. When professional standards review organizations were legislated in the early 1970s, health care quality assurance programs focused on patient outcome. Laboratories, however, maintained a process criteria orientation.

In the early 1980s, the Joint Commission on Accreditation of Hospitals etablished standards for quality assurance programs that reflected both process and outcome approaches. Today, the JCAH is focusing accreditation as well as its quality assurance approach on outcome alone. It calls its accreditation plans ?a historic agenda for change."

What does this mean for the laboratory? Primarily, monitoring by lab management and staff will have to go beyond how well testing is performed to the impact it has on the patient.

Until now, laboratories have felt satisfied if test results met certain acceptable, quantifiable quality control standards. The relationship of QC programs to overall quality of care and hospital risk management concerns was something left to the hospital's utilization review committee, quality assurance program, or peer review organization. This is not feasible with DRGs and the new JCAH focus.

The JCAH has just started a four-year quality assurance development program. In the 1987 accreditation process, clinical outcome measurements will be used as indicators of quality. The commission will create a national database that will reflect existing quality assurance and utilization review systems, modifying it according to local and institutional needs. For the laboratory, this means a focus on delivery systems, appropriateness of testing procedures, and clinical relevance of diagnostic data. The laboratory will then be judged on overall performance as it affects quality of care.

According to the JCAH, there will be a need for "performance measures that are measurable, with a high potential to differentiate good from substandard performance and really mean something." The laboratory will be expected to be more assertive in counseling physicians about appropriate selection of tests, interpretation of results and correlation with othe patient data, and the impact of results on risk management overall.

Risk management deals with maintaining financial stability and preventing injury to patients, visitors, employees, or property, while quality assurance stresses optimal care and improved performance. The goals may seem different, but they overlap and complement each other. Both aim to improve the delivery of care and reduce liabilities.

To meet JCAH standards, you should include in your present quality assurance program a system to evaluate the outcome of pickup times, turnaround times, use of Stat and timed requests, clinical appropriateness of key diagnostic tests, and individual employee competence. The system should also have a monitoring process and a mechanism for reporting results quantitatively. These areas are as important as test results to quality patient care.

If you have not already seen it, consult the JCAH Quality Assurance Manualf it has good ideas for appropriate quality assurance programs. If you are presently approved by the College of American Pathologists, you must still meet the JCAH standards. The CAP is required to have a system equal to or better than the JCAH's to maintain its JCAH deemed status.

The biggest problem for labroatory management will be expanding the laboratory's focus to recognize its role as part of the health care team in total patient care. Changing the attitude and specialized orientation of laboratory practitioners will not be easy. But outcome-focused quality assurance programs need a health care team approach to total patient care. Just turning out correct results is not enough anymore.
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Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Date:Feb 1, 1987
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