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.1

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,2 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.

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 Table 1.

For the introduction of the Childhood Asthma ICP3 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.

The actions involved in introducing this ICP were as follows:

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  Setting up a working group to analyse the situation in this health care area and the introduction of the ICP and to formulate recommendations.

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  Creating the specific representation (algorithm) at local level, which makes it possible to show what, when, how, where and by whom ICP activities are developed, and to identify the critical points for patient safety.

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  Defining the ICP indicators and guaranteeing periodic assessment of them in the CMU.

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  Formulating a communication and training plan aimed at:

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    Paediatricians, nursing staff and pharmacists in the health districts of Granada, with the appointment of a medical/nursing point person in each district.

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    Training in performing spirometries in Primary Care, with a protocol for administration of bronchodilators and proposals for safety measures when doing so.

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  Setting up the follow-up and continuous improvement group in the area of continuity of care.

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  Creating improvement groups with users: school workshops with training for teachers, educational material for children and surveys to evaluate it.

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.

For the Early Childhood Care ICP,4 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).

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 Media5 and Tonsilloadenoidectomy6 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.

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.

There are plans to introduce a Tonsilloadenoidectomy ICP and the recommendations in the clinical practice guidelines are currently being applied.

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.