Improving Quality in Outpatient Services  book cover
1st Edition

Improving Quality in Outpatient Services

ISBN 9781439850602
Published June 22, 2011 by Productivity Press
300 Pages 29 B/W Illustrations

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Book Description

A valuable reference for those involved in the field of ambulatory patient care, Improving Quality in Outpatient Services offers time-tested instruction on how to create a world-class outpatient program. It supplies a high-level overview of current opportunities, national quality programs, and challenges—outlining the policies, procedures, and plans required for success.

Stimulating readers with a wealth of practical applications, stories, and examples, the book details the governance, medical staff, and quality structures required to create, implement, and maintain a safe and efficient outpatient program. It introduces powerful techniques for infection control, medication management, risk prevention, and the elimination of medication errors. It also:

  • Lists mandatory policies and procedures
  • Contains practice drills to prepare you for real-world scenarios
  • Explains how to create a report card to measure quality at all levels
  • Includes a sample curriculum that outlines the courseware required by OSHA and other licensing and regulatory agencies

The authors address documentation and human resources factors and supply an abundance of information and resources in the appendices, including how and where to apply for certification, medical record review tools, policy and procedure checklists, and a state-by-state listing of resources available for outpatient and ambulatory programs. Explaining how to involve patients in the decision making process, the text details a proven system for evaluating quality at all levels of your organization.

Table of Contents

Defining Outpatient Healthcare
Outpatient Quality
National Health Statistics Reports
Outpatient Quality Initiatives (HOP QDRP)
Clinical Performance Measures for Ambulatory Care
ASC Quality Collaboration
American Medical Association (AMA)
Safe Injection Practices Coalition
Safe Practices for Better Healthcare

Creating a Structure for Quality and Safety

Simplicity Is Best
Tie Your Quality Strategy to Your Mission, Vision, and Values
Appoint a Governing Body
Leader Selection
The Medical Staff, Nurses, and Allied Health Professionals
Meetings, Minutes, and Keeping a Calendar
Quality Program Topics

Engineering the Customer Connection
Quality Function Deployment
Plan, Do, Check, and Act (PDCA), and Six Sigma
Three Types of Waste
CSP Number 1: Keep Wait Times to a Minimum
CSP Number 2: Make a Good Impression
CSP Number 3: Be Open and Honest
CSP Number 4: Don’t Blame the Customer
CSP Number 5: Ask Questions
CSP Number 6: It’s Not a Meat Market
CSP Number 7: Follow Through
CSP Number 8: No Medical Mumbo Jumbo
CSP Number 9: Work as a Team
CSP Number 10: Relate to the Person

Policies, Procedures, and Plans
Staying True to Your Mission, Vision, and Value
Creating Lean and Useful Documents
Regulatory Requirements for Documents
The Users of Policies, Procedures, and Plans
Use Reference Manuals and Association Books
Document Format
Documents to Create and Have on Hand
Reviewing and Revising Your Documents

The Human Resource Factor

Quality and the HR Factor
Creating Complete HR Files
Health Care Quality Improvement Act (HCQIA) of 1986
Vendor and Contract Files
Clinical Contract Employee Requirement and Files
Monitoring, Collecting, and Analyzing Data
HR Training to Promote Safety and Quality
Audits and Auditors

Measuring Quality and SafetyMeasurement
Induction, Deduction, and the Scientific Method
Case Study
Scorecards for Outpatient Services
Rewarding Based on Performance

Medication Safety
Safety Overview
Formulary, Consulting Pharmacist, and Tools
High-Alert Medications
Look-Alike Sound-Alike Medications (LASAs)
Contrast Media
Injection Safety and Multiuse Medication Vials
Labeling Medications and Containers
Medication Reconciliation
Sample Medications
Storing and Securing Medications
Medication Safety Reporting
Adverse Drug Reaction Reporting

Infection Prevention in the Ambulatory Setting
Infection Prevention and Control
Infection Control and Prevention Structure
Disaster Planning and Outbreak Investigation
Infection Control and Prevention Committee
Infection Control and Prevention Plan
Bloodborne Pathogens
Sharps: Engineering Safety Mechanisms
Multiuse Vials and Single-Use Vials
Environmental Cleaning and Disinfection
Sterilization, Disinfection, and Cleaning
Recommended Sterilization Resources
Mandatory Staff Training in Infection Prevention
Infection Prevention Resources

Clinical Documentation
Meaningful Use
Electronic Health Records (EHRs)
Meaningful Use Quality Implications
The Purpose of Clinical Documentation
Authentication and Completion of Medical Records
Problem Lists
Allergy and Sensitivity Documentation
Ambulatory Surgery Center Documentation
Security and Retention of Medical Records
Regulatory Requirements

Risk Management and Safety
Challenges and Opportunity in the Ambulatory Setting
Common Causes of Errors in the Ambulatory Setting
Building Your Safety Program
Patient Safety Culture
National Patient Safety Goals
Universal Protocol
Surgical and Anesthesia Safety
Airway Maintenance
Malignant Hyperthermia
Postanesthesia Monitoring
Environmental Safety
MRI Safety
Radiation Safety
Surgical Fires
Work Flow Analysis and Redesign
Safety Program Training
What to Do If You Experience a Safety Event
Use of RCA and FMEA Tools

Licensing, Deemed Status, Accreditation, and Certification
Defining Licensing, Deemed Status, Accreditation, and Certification
Why Become Accredited?
Certification of Programs
Ambulatory Accreditation and Certification Programs
Survey Preparation
Accreditation Listing

Practice Makes Perfect
Why Practice?
5 Whys
Using Checklists to Improve Safety and Quality
Codes and Drills
Scenario Training
Scenario Example for Endoscopy

Checklist on Policies, Procedures, and Plans for an Outpatient Setting
Quality Glossary
Quality Reporting Measures
Infection Prevention Plan Example
Risk Assessment
Medical Record Review Criteria Audit
Safety Management Program
Root Cause Analysis and Corrective Action Plan
State Contacts for Ambulatory Licensing and Standards
Patient Education Pathway Example


Each chapter concludes with a Summary, Key Points, and Sources

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Carole Guinane is a healthcare executive with extensive experience in all aspects of clinical operations, risk management, quality, compliance, regulations, accreditations, medical staff affairs, and insurance in the acute care inpatient and outpatient setting.

Ms. Guinane has over 30 years of experience helping organizations with people and process issues. She has published widely and is nationally recognized as a writer, speaker, consultant and change agent and trainer on topics such as clinical improvement and innovation, leadership, systems thinking, strategic planning, customer-mindedness, Six Sigma, creating a corporate culture, working through change and clinical pathways. Ms. Guinane is a licensed RN and a Six Sigma Black Belt. She also serves on the editorial board for the Heart Hospital Journal and the Journal for Healthcare Quality.

Noreen Davis, RN, MPH is currently the Directory of Quality Outcomes Management for CMC-Union where she has fiscal and supervisory responsibility for Performance Improvement, patient safety, case management and infection prevention and control. She is also responsible for all National Quality Measure data collection and reporting and is the liaison with the medical staff for evidence based order sets.

Ms. Davis is a published author and has completed her black belt in Six Sigma. She is a member of the NAHQ (National Association for Healthcare Quality) and holds a Masters of Public Health from UNC-Chapel Hill.


… hits the mark as both a roadmap and practical guide. … Carole Guinane and Noreen Davis bring a wealth of practical experience to the table … . Their nursing backgrounds coupled with their strong business and public health experiences in ambulatory care provide a foundation for understanding critical segments of the industry where change is sweeping through the care delivery model. …provides both a broad visionary direction for where we need to go in outpatient care management but also provides the details which must be considered as part of our efforts to lead the future of healthcare delivery.
—Kevin Fickenscher, MD