Quality Assurance in Dialysis

This is a time in history when the concept of Quality is reaching new highs in terms of public awareness. Articles describing quality, CQI, quality tools, critical success factors, failures, and lessons learned appear in local news­ papers, trade journals, scientific periodicals, and professional publications on a daily basis, yet implementation of a quality system in many hospital units is approached with caution and the basic tenants of quality systems and CQI continue to be misunderstood. In the United States, today, the public debate on healthcare issues rages on. The application of strategies, such as cost-benefit analysis as a means of new technologies to the healthcare cost structure has for evaluating addition not succeeded in curbing the rise in costs of healthcare services. of this focused attention by third-party payers, federal and state Because governments, and insurance companies, healthcare organizations are being of the strategies for changing involves implementing pressured to change. One quality assurance practices. The focus on quality should produce improvements in productivity, innovation, and profitability. But, most importantly, the desired outcome of a quality assurance program is self-improvement. The concept of quality assurance is increasingly recognized as an essential component in the delivery of medical care. It has come into particular focus in the area of kidney failure and its treatment by dialysis because the customer for this care truly enters into a lifetime relationship with his health care providers. The present handbook provides perspectives for those wishing to design and employ quality assurance principles and those of continuous quality improvement in the arena of end-stage kidney failure and its treatment, whether by dialysis or transplantation. Quality assurance principles are considered to be an inherent part of medical training and are commonly assumed to be utilized. The present work permits an interested reader to assess the validity of this assumption and, if found wanting, it provides the tools to introduce these principles as key components of staff training and practice conduct. Contributions in this book have been drawn from leading experts and, as such, represent a variety of perspectives, each with the focus of providing guidelines for introducing quality assurance into the medical care of patients with kidney failure Front Matter....Pages i-xii Quality assurance: Starting a program in dialysis....Pages 1-9 Patient and therapy perspectives: Choosing the patient “is better worse?”....Pages 11-21 Quality systems in the dialysis center: Peritoneal dialysis....Pages 23-45 Continuous quality improvement in dialysis: Operations and controls for multi-center systems....Pages 47-62 Quality of care in home dialysis....Pages 63-83 Water treatment for hemodialysis....Pages 85-107 The impact of membrane selection on quality assurance in dialysis....Pages 109-131 Quality of life assurance in hemodialysis....Pages 133-149 Dialyzer reuse and the quality of therapy....Pages 151-154 Multicenter trials as a measure for improving the quality of clinical decisions....Pages 155-166 Quality assurance in renal transplantation....Pages 167-190 Quality assurance in dialysis product manufacturing....Pages 191-211 Human resource issues in quality management....Pages 213-223 Quality criteria for the clinical record....Pages 225-238 Continuous quality improvement and the best demonstrated practices program....Pages 239-251 Back Matter....Pages 253-258 This handbook provides perspectives for those wishing to design and employ quality assurance and continuous quality improvement principles in the arena of end-stage kidney failure and its treatment, whether by dialysis or transplantation.