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The Committee
on Quality Management and Departmental Administration
(QMDA) is responsible for continuously reviewing all
matters pertaining to peer review, quality management,
departmental administration and medical staff issues
relevant to the membership’s practice of anesthesiology.
Additionally, the committee serves as the liaison
to the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), the Accreditation Association
for Ambulatory Health Care (AAAHC) and the American
Association for Accreditation of Ambulatory Surgical
Facilities (AAAASF). Typically, the committee meets
in person twice annually; however, members of the
QMDA committee communicate extensively, usually on
a daily basis, and complete ASA “business”
year-round through an ASA electronic listserv.
Liaison Activity
For the past two years, JCAHO staff
has been engaged in intensive reviews and analyses
of the commission’s standards for its six accreditation
programs: ambulatory care, behavioral health care,
home care, hospitals, long-term care and laboratories.
JCAHO intends to rewrite standards chapters for all
six of these accreditation programs with a current
review and approval timeline to facilitate publication
of the rewritten standards by late summer 2003, with
planned implementation in January 2004. For example,
JCAHO is making major changes in its hospital accreditation
program (HAP), both in form and substance, to extend
the value and relevance of JCAHO hospital accreditation.
The new process, known as “Shared Visions —
New Pathways,” attempts to make the HAP useful
in strategic planning. The survey standards of greatest
interest to anesthesiologists are in the “Medication
Management,” “Performance Improvement”
and “Medical Staff” chapters. Jerry A.
Cohen, M.D., Rebecca S. Twersky, M.D., Robert S. Lagasse,
M.D., and Walter G. Maurer, M.D., serve as ASA’s
representatives and alternate representatives to the
JCAHO Professional and Technical Advisory Committees.
AAAHC is the original multidisciplinary
accreditation organization that focused exclusively
on ambulatory health care and is currently a leader
in the accreditation of all types of ambulatory care
organizations, including ambulatory surgical facilities,
college and university health centers, single-specialty
and multispecialty group practices and health networks.
Jeffrey L. Apfelbaum, M.D., and Thomas A. Joas, M.D.,
represent ASA on the AAAHC Board of Directors. Beverly
K. Philip, M.D., and Raafat S. Hannallah, M.D., currently
represent the Society for Ambulatory Anesthesia on
the AAAHC Board of Directors. These members represent
the broad interests of anesthesiologists in all matters
pertaining to ambulatory care. For example, at the
request of the ASA Committee on Pediatric Anesthesia,
the AAAHC Board of Directors recently considered and
recommended adoption of the following new standard
in the accreditation of ambulatory surgical facilities:
“The organization develops and maintains a policy
defining the care of pediatric patients, if relevant.”
AAAASF was formed in 1992 to accredit
single-specialty and multispecialty surgical facilities.
AAAASF currently accredits more than 800 office-based
surgical practices. Of note, AAAASF has recently adopted
an anesthesia standard that requires that “the
qualified physician who is responsible for supervising
the administration of anesthesia must demonstrate
knowledge in anesthetics and resuscitative techniques
appropriate for the type of anesthesia being administered.”
Dr. Apfelbaum represents ASA on the AAAASF Board of
Directors.
JCAHO Compliance Toolkit
The ASA Web site now features an interactive program
that answers anesthesiologists’ questions about
complying with various JCAHO policies, guidelines
and standards. The toolkit has been designed to assist
ASA members responsible for their department’s
compliance with JCAHO requirements.
The toolkit is maintained by Dr. Lagasse along with
the QMDA committee, ASA Web Site Administrator Anita
Abbatacola and Director of Information Services Janice
L. Plack. The toolkit can be found at <www.asahq.org/clinical/toolkit/toolkithome.htm>.
Quality Improvement Template Task Force (QITTF)
The QMDA committee and the Committee on Performance
and Outcomes Measurement (CPOM) are involved in a
joint project to develop an ASA Quality Improvement
Template that can be used “off the shelf”
by anesthesiology departments to improve quality of
patient care and to meet various internal and external
requirements (e.g., accreditation). The need for such
a template is apparent from requests received by the
QMDA committee from many ASA members as well as from
findings of the ASA Anesthesia Consultation Program.
From the CPOM standpoint, a quality improvement module
would form a solid foundation for an ASA national
clinical outcomes database. Quality improvement data
collected according to the template would presumably
be stored in a local database, and because the template
would include a standardized format, the data could
subsequently be deposited in a national database and
used for benchmarking. QITTF is co-chaired by Vincent
L. Hollerich, M.D., representing CPOM, and Dr. Lagasse
from the QMDA committee, with various section leaders,
including Ronald A. Gabel, M.D., J. Kent Garman, M.D.,
Alan P. Marco, M.D., and William R. Mazzei, M.D.
ASA Anesthesia Consultation Program
Under the leadership and direction of James S. Hicks,
M.D., the ASA Anesthesia Consultation Program has
continued to thrive. Since 1982, ASA has had in place
a program offering on-site consultations to hospitals
and departments of anesthesiology seeking assistance
with the evaluation of their anesthesiology services.
The strength of this program is acquired from the
combined experience of the members of the QMDA committee,
guided by a set of program objectives that have existed
almost unchanged since mandated by the ASA House of
Delegates in 1981 (later revised by the House in 1984
and 1989), supported by ASA policies, guidelines and
publications and applied using a comprehensive protocol,
which assures that every significant facet of a department’s
performance is assessed during consultants’
visits. This program remains one of the most visible
ways that ASA serves its members and the public in
general and is one of the primary missions of the
QMDA committee. The committee continues to examine,
fine tune and promulgate this program. To date, there
have been 174 requests for consultations, of which
144 have resulted in completed site visits. Committee
members participating in recent consultations were
Zeyd Y. Ebrahim, M.D., Dr. Hicks, Eric W. Mason, M.D.,
Dr. Mazzei, William R. Montgomery, M.D., and John
M. Zerwas, M.D.
Manual for Anesthesia Department Organization
and Management (MADOM)
MADOM continues to be an exceptional work product
of the QMDA committee, with its most recent edition
published in January 2003. MADOM is designed to be
a compilation of much of the administrative information
required by the leadership of an anesthesiology department
in any setting (hospital, office, private practice
or university). It serves to educate ASA members to
recognize their individual and collective responsibilities
as members of their medical staffs, departments, groups
and managed care organizations. It has proved to be
an extremely valuable resource to the membership and
continues to be the primary reference document used
in the ASA Anesthesia Consultation Program. MADOM
is currently available in both print and electronic
forms. Dr. Apfelbaum and Dr. Hicks serve as editors-in-chief
of the current edition of MADOM, with Dr. Cohen, Robert
E. Johnstone, M.D., Dr. Montgomery, Dr. Philip, Susan
L. Polk, M.D., and Dr. Zerwas serving as associate
editors/chapter chiefs.
2002 ASA Annual Meeting Panel Discussion
At the 2002 Annual Meeting, the QMDA committee conducted
a panel discussion called “QA? Sedation? A 2002
Accreditation Survival Kit.” Discussants included
Dr. Apfelbaum, Dr. Cohen, Dr. Gabel, Dr. Hicks and
Dr. Lagasse. Audience participation was brisk and
included a multitude of ASA members and JCAHO surveyors.
The QMDA committee is dedicated to serving the ASA
membership and welcomes inquiries in any area that
falls within our mission.
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Jeffrey L. Apfelbaum, M.D., is Professor and
Chair, Department of Anesthesia and Critical
Care, University of Chicago Hospitals, Pritzker
School of Medicine, Chicago, Illinois. |
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