Subject(s)
Communication , Medical Errors , Patient Satisfaction , Professional-Patient Relations , Australia , Humans , New Zealand , Patient SafetyABSTRACT
BACKGROUND: The purpose of credentialing is to ensure that clinicians provide safe, high-quality health-care services in accordance with good practice and legal requirements. This review assessed the institutional credentialing processes and governance structures required to support credentialing processes at an institutional, regional or health-care system level. METHODS: Searches of MEDLINE, EMBASE and PubMed were conducted. Additional grey literature searches were performed using the Google search engine and specific searches of government web sites were conducted. The inclusion criteria were developed a priori and standardized extraction of the information to appraise the research questions was conducted systematically. RESULTS: A total of 33 white papers were included in this systematic literature review: 18 were published in Australia, 1 in New Zealand, 10 in the United Kingdom, 2 in the United States of America and 2 in Canada. Four key principles were common throughout all studies included in this review: clear lines of responsibility for the credentialing process and supportive governance structures, clear standards for credentialing, a culture of continuous improvement and evaluation of credentialing process outcomes. CONCLUSIONS: No data were available to evaluate the relationship between the credentialing process and the safety and quality of health-care services or patient outcomes; and capturing such data is difficult because of the numerous factors that affect the relationship between credentialing, patient outcomes, and the safety and quality of health-care services. Consequently, developing methods to measure the effectiveness of credentialing processes represents an area for further research.
Subject(s)
Credentialing , Specialties, Surgical , InternationalitySubject(s)
Hospital Units/organization & administration , Specialties, Surgical/organization & administration , Specialties, Surgical/trends , Surgical Procedures, Operative , Trauma Centers/trends , Australia , Emergencies , Emergency Treatment/trends , Forecasting , Hospitals, Public , Humans , Needs Assessment , Operating Rooms/organization & administration , Specialties, Surgical/educationABSTRACT
The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home-call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on-site consultant. In addition, the ACS model provides greater consultant supervision to the trainee.
