Accreditation for ultrasound in the world

To assess accreditation for ultrasound (US) throughout the world, a questionnaire was sent to 34 doctors in 34 countries; 23 of them responded. Clinical specialties are approved by law in the large majority of countries, except for a few countries like the USA or Japan. The position of "Sonologist", who is a specialist for US, has not been established in any of the countries with the exception of China. In some countries, some kinds of technicians are permitted to be involved in US after training and the recipients of such accreditation are usually called "Sonographers." Accreditation systems for US in various countries were classified into three grades, namely, "Should," "Would" and "Might," according to differences in regulations, education and certification. In 19 out of 23 countries, grading fell into the "Might" grade, in which accreditation is thought to be no more than a matter of morals. It is concluded that a respective accreditation system suitable to the country would be constructed independently.

Special features topic: the effects of limited work hours on surgical training in otolaryngology-head and neck surgery

PURPOSE OF REVIEW

This paper reviews the historic events that culminated in the development of duty hour regulations, and then discusses many of the problems being encountered as the regulations are implemented.

RECENT FINDINGS

On July 3, 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted duty hour requirements for residency training programs in the United States. Although these regulations should have come as no surprise to graduate medical education programs, many were nevertheless unprepared for their implementation. In comparison to duty hour restrictions currently in place in European countries, those being implemented in this country are much more lenient. Both the fiscal and the educational impact of these requirements on graduate medical education are substantial. Recent accreditation actions taken against a training program at Johns Hopkins University clearly demonstrates that the ACGME is prepared to strictly enforce these standards.

SUMMARY

The impact of the new duty-hour requirements on residency training and education will be a matter of great interest as they are implemented throughout the graduate education system in the United States.

Results of the first 100 accreditation procedures in France

PURPOSE

To identify the areas of needed improvement that were most frequently identified in the first 100 accredited hospitals by the French Accreditation College (FAC) according to the standards manual. To compare the outcomes of accreditation procedures according to the status and size of the accredited hospitals.

DATA SOURCES

We analyzed the first 100 summaries of accreditation reports available on the website of the Agence Nationale d'Accréditation et d'Evaluation en Santé (ANAES).

DATA EXTRACTION

Data were collected on hospitals, accreditation processes, and outcomes (decisions of the FAC). For each decision, we assessed the relationship with accreditation manual criteria, and analyzed their distribution by chapter.

RESULTS

of data synthesis. Among the 100 accredited hospitals (40 public, 43 private, 17 mixed), nine were accredited without recommendations for improvement, 47 with recommendations, 40 with reservations, and four with major reservations. All of them received requests for improvement. No significant difference was found concerning the FAC decisions according to status and size of hospitals, although there was a trend that the larger the hospital, the more numerous and more serious the decisions of the FAC. The main topics addressed by decisions were those given high priority by the FAC (information given to patients and its traceability on patient records, and signing of prescriptions for medication).

CONCLUSION

Despite wide heterogeneity in the summaries on accreditation and in FAC decision-making, this study provides an initial insight into common quality defects and ANAES priorities for hospitals in France.

Medicare and Medicaid programs; hospital conditions of participation: quality assessment and performance improvement. Final rule

This final rule requires hospitals to develop and maintain a quality assessment and performance improvement (QAPI) program. In the December 19, 1997 Federal Register, we published a proposed rule to revise the hospitals conditions of participation (CoPs). The QAPI CoP was one of the conditions included in the proposed rule. We separated the QAPI CoP from the larger set of hospital CoPs so that it could be published in advance of the remaining CoPs to implement the Administration's initiatives regarding medical errors. QAPI focuses provider efforts on the actual care delivered to patients, the performance of the hospital as an organization, and the impact of treatment furnished by the hospital on the health status of its patients. Specifically, it is important to note that a QAPI is not designed to measure a hospital's quality, but rather a minimum requirement that the hospital systematically examine its quality and implement specific improvement projects on an ongoing basis. State agencies (SAs) during their surveys, review all aspects of a hospital's operations and this review provides a framework in which the SA can assess a hospital's QAPI program. In addition, the QAPI entails all activities required for measuring quality of care and maintaining it at acceptable levels. This typically includes; 1) Identifying and verifying quality-related problems and their underlying cause; 2) Designing and implementing corrective action activities to address deficiencies; 3) Following up to determine the degree of success of an intervention and to detect new problems and opportunities for improvement. Performance improvement activities aim to improve overall performance assuming that there is no permanent threshold for good performance. Under performance improvement framework, hospitals will continuously study and improve the processes of healthcare and delivery of service.

Health care quality information liability & privilege

As the General Counsel for the National Committee for Quality Assurance, which accredits health plans and measures outcome performance, Ms. Donohue is in a unique position to comment on the use of such data in litigation against health plans and providers. After reviewing the growing tide of class-action lawsuits in this area, she argues that such information should be protected under the common law privilege of self-critical analysis, extended to third parties, because such privilege would protect and encourage quality assessment. Ms. Donohue further argues that the sharing and reporting of this information on a system-wide level will allow plans and providers to make visible headway in improving the care provided to patients, and that this benefit to all consumers clearly justifies the creation of a federal privilege to combat the abundance of state-level lawsuits against plans and providers that attempt to base liability on third-party accreditation and outcome performance data.

[Genetic fingerprints and computerised databases]

The computerised databases of genetic fingerprints are laboratory tools and by extension law enforcement tools, for which the European Union has defined the applications. As these genetic profiles give no information on specific hereditary characteristics, these bases have been established in order to respect the rights and fundamental liberties of each individual. Compatible at the international level, nobody contests today their rewards in the fight against crime.

[The Istituto Superiore di Sanità, the organization responsible for the evaluation and accreditation of food product testing laboratories ]

Laboratories in charge of food control play a pivotal role within the actions planned for the safety of food products, the latter identified as a fundamental strategic priority in the European Union Food safety white paper 2000. They are demanded to comply with specific criteria to demonstrate the use of an appropriate quality system, technical competence and production of technically reliable and valid results. Precise guidance is set forth in the Italian law DL. vo 156/97 which requires that official test laboratories should comply with European Standard UNI CEI EN 45001, currently replaced by UNI CEI EN ISO/IEC 17025. and with some of the OECD principles of good laboratory practice. The Istituto Superiore di Sanità, the Italian National Health Institute, was designated by the Ministerial Decree of 12 May 1999 as the organism responsible for evaluation and accreditation of official food product control laboratories.

[Chemical compound safety: typology of competency accreditation for assay centers and analytical laboratories]

The use of chemicals warrants many benefits on which modern society is entirely dependent. On the other hand, the lack of reliable information about the impact of the use of chemicals raises increasing concern. In order to guarantee the safety of chemicals it is mandatory to proceed to risk assessment, which in turn consists of hazard evaluation and exposure estimation. These activities are strictly dependent upon the availability of reliable data and information, produced by, e.g., test facilities, test laboratories and clinical laboratories, the specific competence of which has been properly recognised. All this applies in the pre-marketing phase as well as during the use of chemical substances. In this latter phase it is necessary to carry out an appropriate monitoring of environment, food and, in specific situations, human beings (biological monitoring). In the field of chemical safety, standards, legal instruments and operative instruments are nowadays available. These tools make it possible to assess both the quality of data and the competence of the entities involved in the production of the data themselves.

[Institutional accreditation: general observations and local specificities]

The article describes the nature and development of the institutional accreditation process in Italy, with reference to the law in force. This process is an administrative act whose objective is the selection of providers for the National Health Service to ensure quality control and to support quality improvement. The general approach adopted by the Italian region of Emilia Romagna to assess health care facilities is also described. Moreover, the article identifies the role of clinicians and the methods adopted to define the appropriate criteria for specialised contexts.