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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.


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March 1, 2013 Volume 77, Number 3
Committee News: QMDA: Quality, Regulation and Accreditation Beverly K. Philip, M.D., Chair Committee on Quality Management and Departmental Administration

The Committee on Quality Management and Depart-mental Administration (QMDA) continuously reviews all matters pertaining to quality management and departmental administration, peer-review and medical staff issues that come to its attention from all sources, including governmental agencies, third-party insurers and accrediting organizations. QMDA also serves as a source for distribution of information on these issues. Members of QMDA are available to consult with departments of anesthesiology and anesthesia organizations.

We welcome questions from ASA members. The QMDA staff liaison is Maureen Amos, M.S., ASA Director of Regulatory Quality Affairs,

Below are some of QMDA’s current active projects.

ASA Consultation Program
William H. Montgomery, M.D., Mark A. Singleton, M.D.
The QMDA Committee supports ASA’s formal consultation program that provides comprehensive analysis of the strengths and weaknesses of anesthesiology departments and makes recommendations for improvement. These are two- to three-day onsite visits by two experienced QMDA members who document and analyze the issues presented, resulting in an ASA report of legally-reviewed assessments and recommendations. Requests for consultation arise from any number of concerns, including leadership, quality of patient care, compliance with regulatory requirements and ASA standards/guidelines/practice parameters/statements, engagement with the hospital’s mission, and willingness or ability to meet demands for additional anesthesia services. In response to frequently encountered problems, consultation reports often recommend specific changes in department leadership and organization, and improvements in communication, quality management systems and integration with hospital programs. In addition, consultations often comment on the adequacy of department resources to meet expectations and the demands of the department’s clinical workload, ensuring patient safety, regulatory requirements and adherence to “community standards.” Recipients of the consultation uniformly report that they are most satisfied with the report and recommendations. Additional information may be obtained from the ASA headquarters office, (847) 825-5586.

United States Pharmacopeial Convention (USP)
H.A. Tillmann Hein, M.D., Ph.D.
USP is a nonprofit organization that sets standards for the identity, strength, quality and purity of medicines, food ingredients and dietary supplements manufactured, distributed and consumed worldwide. USP’s drug standards are enforceable in the U.S. by the Food and Drug Administration, and hence the Centers for Medicare & Medicaid Services (CMS), and deemed accrediting organizations as well as state law. The standards are utilized in more than 140 countries. USP not only sets standards for substances used as medication, it also sets standards for manufacturing and compounding of medications. The latter came to public attention when in 2012 an outbreak of fungal meningitis was linked to compounded methylprednisolone, likely related to violations of USP Chapter 797. Unrelated to the recent scandal, anesthesiologists remain concerned about the “one-hour-rules” also in Chapter 797. ASA – through its delegate to the USP Convention, Dr. Hein – has made presentations to USP voicing its concerns regarding this set of rules, which do not appear to have scientific data to support them. The rules are being reconsidered at this time.

The Joint Commission (TJC)
Michael B. Simon M.D., Mark A. Singleton, M.D.
The relationship between ASA and the Joint Commission continues to be collegial, with the Professional and Technical Advisory Committee process allowing us review of the standards creation process. The Joint Commission is currently rolling out its National Patient Safety Goals for 2013. They include:

  • Identifying patients correctly using two identifiers.
  • Making sure correct patients get correct blood.
  • Improving staff communication.
  • Using medications safely.
  • Preventing infections, specifically dealing with central lines, hand-washing, surgical infections and urinary catheter-related infections.
  • Preventing mistakes in surgery, with a recommendation to use the Joint Commission’s Targeted Solutions Tool™ (TST) products. There have also been preliminary discussions regarding device alarm management, for the future. The Joint Commission also has an online process whereby our representatives can directly access comment, via the Standards Interpretation Group. This year saw the final framework development for the Joint Commission’s Primary Care Medical Home designation. It’s noteworthy that a physician is not necessarily the leader of the team; rather, it is the “primary care clinician.”

  • Det Norkse Veritas (DNV)
    Laura I. Dew, M.D., Colleen E. O’Leary, M.D.
    DNV received initial deeming status as an accreditation agency for hospitals in 2008, the first new CMS-approved accreditation program in more than 40 years. It is the first to integrate NIAHO® accreditation with ISO 9001 Quality Management System Standards. DNV also has deeming status for Critical Access Hospitals and application for Ambulatory Centers is in progress. Currently, 255 hospitals have been accredited by DNV, and 320 hospitals are under contract. DNV has requested that ASA provide a liaison for its industry-wide leadership Advisory Group, and Dr. Dew has been appointed. The initial meeting of this group will be in the first quarter of 2013.

    DNV had its 1st Annual Symposium on Accreditation, Quality and Patient Safety on October 29-30, 2012 in Houston, with over 200 attendees. DNV President, Yehuda Dror, and DNV Global Safety Officer, Karen Timmons (former CEO of Joint Commission International), provided opening statements. Patrick Horine, DNV’s EVP, presented the CMS updates. In addition, there was a comprehensive discussion of the development of quality management systems as well as bio-risk (infection control). The symposium also presented the DNV Technology Outlook for 2020, which for the first time in DNV history was about the health care sector. It is available online at

    Practice Metrics
    Laura I. Dew, M.D.
    The QMDA and Practice Management committees have a joint workgroup that is developing a toolbox of metrics that anesthesia groups can use to measure their practices. The metrics are parameters that anesthesia practices can use to demonstrate quality and value to their providers and payers. These metrics will be easily collected by groups of any size, whether private or academic. These metrics should be under anesthesia control and measurable. The workgroup will identify metrics that groups can use to assist with negotiations for anesthesia contracts with providers and payers.

    Manual for Anesthesia Department Organization and Management (MADOM)
    Richard P. Dutton, M.D.
    The QMDA Committee will soon unveil the new, online edition of the Manual for Anesthesia Department Organization and Management (MADOM). This resource has long been available to ASA members as a one-stop shop for information on how to run an anesthesia department. It includes chapters on departmental leadership, regulatory requirements, scheduling and efficiency, billing compliance and quality management, among others. MADOM is known for its practical nature and generous inclusion of examples. Moving online, MADOM will be able to link to ASA and external references and to provide examples of key policies and practice documents contributed by successful practices. We will also include new material on hot topics such as emerging models of care, selection and installation of electronic record systems, and guidelines for response to natural or man-made disasters. Our goal is to make the MADOM site an enduring reference for ASA members and the fastest way to find the up-to-date administrative assistance you need.

    Beverly K. Philip, M.D. is Professor of Anaesthesia, Harvard Medical School, Founding Director, Day Surgery Unit, Brigham and Women’s Hospital, Boston.

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