Quality of care clinic related issues review of the cpso ihf guidelines
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Quality of Care Clinic related issues review of the CPSO IHF guidelines. Michael Gould MD FRCPC.

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Quality of CareClinic related issuesreview of the CPSO IHF guidelines

Michael Gould MD FRCPC

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SummaryIn an effort to improve the quality of endoscopic services in the ambulatory setting, the College of Physicians and Surgeons of Ontario (CPSO), under the direction of the Ministry of Health, created a committee of stakeholders to develop Independent Health Facility (IHF) guidelines for ambulatory endoscopy. The IHF model that the CPSO used for the plastic surgery ambulatory care centres, was used as a template. The guidelines were fairly comprehensive and I will review the important points from the guidelines. I will try and highlight those areas where there is perceived to be the greatest deficiencies in the multiple endoscopy clinics currently in operation

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CPSO endoscopy IHF process

  • Request from MOH to accredit centre in SWO

  • Use the existing IHF template from Surg. centres

  • All endoscopic services included, brochoscopy and Cystoscopy

  • All aspects of the endoscopic process included

  • Multidisciplinary

  • This presentation will not discuss endoscopist credentials and issues, discussed in other presentation

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CPSO IHF process committee members

  • Dale Mercer Surgeon chair ( former CPSO pres.

  • GI- Gould, Catherine Lowe

  • Resp- Noe Zamel

  • Anaesthesia, John Bradley

  • Gen Surgery. Angus MacIver, Sandy McDonald

  • Nursing Celia Neto

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Quality issues

  • This is a discussion about best practice

  • Data lacking on many fronts

  • Most of us follow standards regardless of Data

  • Standard of practice from hospitals used as baseline

  • Since less backup, plan for IHF higher standards

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Quality issues

  • Facility standards

  • Staffing

  • Physician- compromise FRCP/S-comment on experience left blank

  • Nursing- registered with college, if sedation used must have at least one RN

  • Reprocessing- trained staff

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Quality issues reprocessing

  • Reprocessing machines are standard, no mention on type yet, non-reusable chemistries only used in Europe

  • Committee agreed manual cleaning now falls below standard of care.

  • Technicians need to be trained

  • Quality control over water, chemicals and all infection control flow issues must be followed and maintained

  • Is there enough room to separate clean from dirty, flow , ventilation, air exchanges

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Quality issues, Patients

  • Appropriate patients, ASA physical status classification statement re level l ASA III-IV

  • Clinics should ensure that Patients with coagulation issues, significant renal dysfn., Insulin dependent diabetics, Significant Cardiac disease, among others, likely benefit from Hospital endoscopy

  • Direct referral, same day consult/scope NB for above

  • IV fluids

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Quality issues

  • Physical layout comments

    • Adequate waiting areas, change area’s patients observed

  • Privacy issues, admission, recovery, discharge, discussion

  • Resuscitation equipment and process, ACLS certified

  • SOP’s done, kept and reviewed

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Quality issues continued

  • Access to hospital for transfer, physicians with privileges in nearby hospitals

  • Emergency power source

  • Mechanism to protect narcotics including locked cabinets

  • Appropriate emergency drugs

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Quality issues con’t

  • Patient records

  • Quality of procedure- skills, data to follow eg. Completion rates, complications, etc.

  • Adequate Sedation- improved completion rates

  • Communications to patients, preps, process etc.

  • Communications back to referring MD’s

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Quality IssuesInfection Control

  • Long section

  • Cleaning of scopes

  • Flow of process dirty to clean without cross contamination

  • Scope storage

  • Ventilation

  • Waste handling

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Quality of CareClinic related issues


Quality trumps business

Once maintain quality good business practices prevail

We don’t want what happened in the cosmetic clinics