Scientific Letter
Importance of integrated care processes in quality accreditation of paediatric clinical management units
Importancia de los procesos asistenciales integrados en la acreditación de calidad de unidades de gestión clínica pediátricas
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Rueda Domingo, M.F. Enríquez Maroto, J.L. Morales Torres, M.A. Fernández Sierra" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.T." "apellidos" => "Rueda Domingo" "email" => array:1 [ 0 => "mariat.rueda.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.F." "apellidos" => "Enríquez Maroto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.L." "apellidos" => "Morales Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.A." "apellidos" => "Fernández Sierra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Calidad Asistencial, Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Importancia de los procesos asistenciales integrados en la acreditación de calidad de unidades de gestión clínica pediátricas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Health care quality certification is a continuous and evolving process which reflects the present state of affairs and the potential for improvement. The Andalusian Agency for Health Care Quality (ACSA), under the authority of the Regional Department of Equality, Health and Social Policies, is the certifying body of the quality accreditation model for hospitals and health care units in this autonomous community.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Clinical Management Units (CMUs) at the Hospital Universitario Virgen de las Nieves de Granada that have successfully completed the process of accreditation by the ACSA include two that treat paediatric patients: Médico-Quirúrgica de la Infancia (Children's Medical/Surgical Unit) and Otorrinolaringología (Ear, Nose and Throat [ENT] Unit). These units received the advanced level certificate, according to the standards model established for CMUs,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> during an assessment process completed in 2011 for the Children's Medical/Surgical Unit, which satisfactorily passed the four-year follow-up visit in 2014, and for the ENT Unit in 2013. Among other dimensions, the standards refer to coordination of person-centred care, including management by integrated care pathways (ICP). The hospital's Health Care Quality Unit advised and participated actively in introducing ICPs and in self-assessment for ACSA accreditation by both CMUs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the Children's Medical/Surgical Unit CMU the ICPs were identified according to its portfolio of services, distributed in two categories as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">For the introduction of the Childhood Asthma ICP<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> meetings were held with professionals from other hospitals and in Primary Care, and they compiled protocols for regulating the flow of patients between Primary and Specialist Care, with criteria for referral, followup and training requirements. Periodic monitoring of quality standards was established.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The actions involved in introducing this ICP were as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Setting up a working group to analyse the situation in this health care area and the introduction of the ICP and to formulate recommendations.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Creating the specific representation (algorithm) at local level, which makes it possible to show <span class="elsevierStyleItalic">what</span>, <span class="elsevierStyleItalic">when</span>, <span class="elsevierStyleItalic">how</span>, <span class="elsevierStyleItalic">where</span> and <span class="elsevierStyleItalic">by whom</span> ICP activities are developed, and to identify the critical points for patient safety.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Defining the ICP indicators and guaranteeing periodic assessment of them in the CMU.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Formulating a communication and training plan aimed at:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Paediatricians, nursing staff and pharmacists in the health districts of Granada, with the appointment of a medical/nursing point person in each district.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Training in performing spirometries in Primary Care, with a protocol for administration of bronchodilators and proposals for safety measures when doing so.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Setting up the follow-up and continuous improvement group in the area of continuity of care.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Creating improvement groups with users: school workshops with training for teachers, educational material for children and surveys to evaluate it.</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Following the publication of a new edition of the Asthma ICP, a follow-up group was convened to update it, design a road map with risk points for patients and conduct training in childhood asthma for education professionals.</p><p id="par0075" class="elsevierStylePara elsevierViewall">For the Early Childhood Care ICP,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> a committee was set up to introduce it, centralised at the provincial health authority, with contacts in hospitals and health districts in the province. Points of particular importance were coordination among early childhood care centres and dissemination to professionals in other fields (socio-educational care centres).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Among the aspects of the ENT CMU that received the most favourable assessment in the certification process, its outpatient work, conducted according to protocols, was highlighted as a strength, with the introduction of specific ICPs for its portfolio of services. For this purpose they carried out a situation and specific representation analysis with local adaptation of the Otitis Media<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> and Tonsilloadenoidectomy<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> ICPs at the hospital. To the specific representation they added the basic points in the clinical history to be carried out and the quality indicators to be monitored periodically after its implementation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the Otitis Media ICP three sub-processes were specified: acute, serous and recurrent acute otitis media, and it was supplemented with explanatory documents, clinical practice guidelines and patient information used in the Childhood ENT consulting room.</p><p id="par0090" class="elsevierStylePara elsevierViewall">There are plans to introduce a Tonsilloadenoidectomy ICP and the recommendations in the clinical practice guidelines are currently being applied.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The work described and coordinated among professionals has helped the two units to achieve accreditation. The introduction of ICPs is a useful tool for continuous improvement and for certification of CMUs that treat paediatric patients, becoming a guarantee of quality for the care of the public.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rueda Domingo MT, Enríquez Maroto MF, Morales Torres JL, Fernández Sierra MA. Importancia de los procesos asistenciales integrados en la acreditación de calidad de unidades de gestión clínica pediátricas. An Pediatr (Barc). 2015;83:57–58.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Phase of introduction \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Compulsory \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Priority \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Introduced \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Childhood asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Early Childhood Care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Introduction started \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tonsilloadenoidectomy Otitis media \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Not introduced (in clinical documentation phase) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever syndrome in children \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab861365.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Integrated Care Pathways by prioritisation criteria and phase of introduction in paediatric units at the Hospital Universitario Virgen de las Nieves de Granada.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Certificación de Centros y Unidades Sanitarias. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 7 | 11 |
| 2024 October | 28 | 50 | 78 |
| 2024 September | 51 | 38 | 89 |
| 2024 August | 55 | 57 | 112 |
| 2024 July | 35 | 19 | 54 |
| 2024 June | 34 | 20 | 54 |
| 2024 May | 40 | 25 | 65 |
| 2024 April | 30 | 38 | 68 |
| 2024 March | 31 | 23 | 54 |
| 2024 February | 35 | 37 | 72 |
| 2024 January | 28 | 26 | 54 |
| 2023 December | 23 | 16 | 39 |
| 2023 November | 25 | 24 | 49 |
| 2023 October | 23 | 23 | 46 |
| 2023 September | 23 | 25 | 48 |
| 2023 August | 24 | 26 | 50 |
| 2023 July | 24 | 28 | 52 |
| 2023 June | 24 | 25 | 49 |
| 2023 May | 38 | 19 | 57 |
| 2023 April | 13 | 17 | 30 |
| 2023 March | 32 | 21 | 53 |
| 2023 February | 20 | 13 | 33 |
| 2023 January | 19 | 21 | 40 |
| 2022 December | 31 | 32 | 63 |
| 2022 November | 37 | 29 | 66 |
| 2022 October | 23 | 43 | 66 |
| 2022 September | 31 | 29 | 60 |
| 2022 August | 25 | 41 | 66 |
| 2022 July | 27 | 49 | 76 |
| 2022 June | 25 | 44 | 69 |
| 2022 May | 23 | 29 | 52 |
| 2022 April | 25 | 35 | 60 |
| 2022 March | 73 | 40 | 113 |
| 2022 February | 33 | 24 | 57 |
| 2022 January | 56 | 36 | 92 |
| 2021 December | 69 | 36 | 105 |
| 2021 November | 32 | 40 | 72 |
| 2021 October | 38 | 53 | 91 |
| 2021 September | 27 | 57 | 84 |
| 2021 August | 19 | 35 | 54 |
| 2021 July | 27 | 40 | 67 |
| 2021 June | 25 | 29 | 54 |
| 2021 May | 35 | 28 | 63 |
| 2021 April | 68 | 52 | 120 |
| 2021 March | 38 | 16 | 54 |
| 2021 February | 19 | 16 | 35 |
| 2021 January | 22 | 23 | 45 |
| 2020 December | 24 | 27 | 51 |
| 2020 November | 17 | 19 | 36 |
| 2020 October | 17 | 24 | 41 |
| 2020 September | 18 | 16 | 34 |
| 2020 August | 20 | 10 | 30 |
| 2020 July | 20 | 21 | 41 |
| 2020 June | 22 | 5 | 27 |
| 2020 May | 25 | 26 | 51 |
| 2020 April | 23 | 12 | 35 |
| 2020 March | 24 | 14 | 38 |
| 2020 February | 23 | 18 | 41 |
| 2020 January | 14 | 15 | 29 |
| 2019 December | 26 | 20 | 46 |
| 2019 November | 20 | 11 | 31 |
| 2019 October | 21 | 13 | 34 |
| 2019 September | 11 | 7 | 18 |
| 2019 August | 33 | 18 | 51 |
| 2019 July | 28 | 15 | 43 |
| 2019 June | 23 | 19 | 42 |
| 2019 May | 30 | 21 | 51 |
| 2019 April | 22 | 19 | 41 |
| 2019 March | 24 | 10 | 34 |
| 2019 February | 29 | 15 | 44 |
| 2019 January | 26 | 21 | 47 |
| 2018 December | 32 | 30 | 62 |
| 2018 November | 43 | 29 | 72 |
| 2018 October | 47 | 26 | 73 |
| 2018 September | 24 | 12 | 36 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 15 | 0 | 15 |
| 2018 March | 16 | 0 | 16 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 8 | 0 | 8 |
| 2017 December | 8 | 0 | 8 |
| 2017 November | 7 | 0 | 7 |
| 2017 October | 10 | 0 | 10 |
| 2017 September | 10 | 0 | 10 |
| 2017 August | 16 | 0 | 16 |
| 2017 July | 14 | 1 | 15 |
| 2017 June | 32 | 9 | 41 |
| 2017 May | 24 | 4 | 28 |
| 2017 April | 15 | 7 | 22 |
| 2017 March | 14 | 3 | 17 |
| 2017 February | 9 | 4 | 13 |
| 2017 January | 13 | 5 | 18 |
| 2016 December | 28 | 6 | 34 |
| 2016 November | 34 | 5 | 39 |
| 2016 October | 45 | 4 | 49 |
| 2016 September | 45 | 3 | 48 |
| 2016 August | 22 | 4 | 26 |
| 2016 July | 13 | 3 | 16 |
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