This is a management method that has shown its validity in the increase of market quotas and benefits, which both satisfies the employees and reduces the costs of medical processes. The concept of continuous quality improvement is based on the ideas developed by Deming after the Second World War, to help the Japanese improve their manufacturing processes in industry. This methodology establishes a series of steps known as the Deming Cycle, Plan-Do-Check-Act. In 1980, the Hospital Corporation of America took the decision to impliment an adapted version of the Deming Method and developed the FOCUS-PDCA cycle: FIND - Identify a process that can be improved. ORGANIZE - Organize a team of people who know the process. CLARIFY - Clarify/examine the process in depth. UNDERSTAND - Identify the causes that produce changes in the process, and SELECT - Select the possible improvements that could be made to the process.

The Mercy Hospital of Miami (USA) is one of the many hospital that has implanted the methods of CQI: This hospital like all the healthcare institutions in USA., are obliged to go through a periodic inspection or review, which is carried out by JCAHO (Joint Commission on Accreditation of Healthcare Organizations) in which samples of documents about the running of the hospital are looked at.

One of the most important areas of the hospital is it's Accident and Emergency Department. Here, the concept of quality improvement is even more necessary, because it's correct running reduces the risk to patients, this is done by shortening the time the patient has to wait for medical attention or in the improvement of the accuracy of diagnosis.

Basing itself on the actual work methods of the Quality Department of the Mercy Hospital, NOVASOFT, has deigned and developed a computerized tool to support the activities of the CQI plan. The tool is based on the experience of the Mercy Hospital. However, given that the hospital's CQI-ED plan is based on a widely accepted methodology, and that the actions to be reviewed (its medical procedures and associated documentation) are based on the recommendations of independent medical organizations, its design is perfectly adaptable to any other similar environment.

Novasoft has undertaken the development of this tool in close collaboration with the Mercy Hospital who have defined the needs of the user. The tool has been designed following the latest technology recommended for this type of application: interface of user Windows and relational data base for the archive of data.

The application consists of modules for

• The elaboration of an annual plan of reviews (PLAN)

• The filling in of registers for each of the designed check lists (DO)

• The filling in of data for daily census and its monthly summary. (DO, CHECK) and

• The production of monthly reports of results and statistics that facilitate the taking of decisions based on results (CHECK,ACT)

PLANMAKING MODULE
This allows us to plan reviewing events during the months of the year in a way that these activities are spread evening.

It also shows the reasons for organizing each particular event, in the Annual Plan (because of high cost, high risk etc.).

This module also presents a global vision of the results of the annual events.

CENSUS MODULE
This allows us to introduce census data from the emergency department, for example the total number of patients seen, patients that go without being attended, patients who die in the emergency department etc.

All the census data can be presented in the form of tables and graphs, with daily or monthly or annual information.

The census data to be registered can be determined by the user in the maintenance module.

REGISTERS MODULE
This module is central to the application as it allows us to introduce review data and to present the results accumulated monthly and annually.

With this module one can make complex searches that result in specific reports for each professional group working in the emergency department. These can be used in meetings designed to follow the quality plan.

MAINTENANCE MODULE
The module includes additional modules for the maintenance of the systems tables like those for the costs of laboratory tests (which are used in the previous module to produce cost reports), census data to be registered, professionals in the department and credentials (licenses), etc.

REPORTS MODULE
This allows us to produce reports of monthly reviews in accordance with the selected events for the user. These reports include the census data for that month and previous months and the comparisons with the year before.

The user can add notes to the review and census data that can be used for discussion about the evolution of the quality plan.

CQI-ED software in being used successfully by Mercy Hospital de Miami for months. To allow U.S.A. market to be reached, NOVASOFT became a partner of STAT AUDITING SOFTWARE, a Miami based company, responsible for all U.S.A. marketing and consultancy services.

That strategy rapidly produced actual results, as demonstrated by the following list of hospitals and organizations:

• Baptist Hospital of Miami (Florida, USA)

• Earl K. Long Hospital (Baton Rouge, Louisina)

• Florida University Hospital Center (Gainesville, Florida)

• Kendall Regional Medical Center (Kendall, Florida)

• Larkin Community Hospital (South Miami, Florida)

• Palo Community Hospital (Palo Heights, Illinois)

• St. Paul's University Hospital (Toronto)

• EmCare Corporation

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