The main reasons we wish to pursue accreditation and certification for pediatric urgent care centers and urgent care centers that provide pediatric care as part of their servicers offered are as follows. To reassure patients the urgent care maintains quality, differentiate from primary care, retail and the ED, to assure payers the facilities we certify or accredit provide and maintain quality to meet hospital quality and safety standards that hospital owned centers will need to comply with and to fulfill any current or future state licensing requirements. Additional benefits may include getting a leg up on competition and potentially standardizing care across states.
(Validating authenticity/ Confirmation that a fact or statement is true)
Certification is more of a confirmation that a given facility is recognized as a pediatric provider of urgent care. It tends to be less comprehensive, less expensive does not require on site surveys has shorter intervals between recertification dates and generally does not include patient safety and quality reviews.
(Act of granting credit or recognition that standards are maintained)
- Accreditation includes the components of certification but goes a bit further by recognizing a facility for maintenance of highest standards in care and management, it is more comprehensive, more costly, has a longer cycle between reaccreditation times, and involves an on-site survey.
Following is a breakdown of components of certifying/accrediting a center and here we break it down into Medical practice standards and facility standards as a way of viewing the process.
Medical Practice Standards
- Board preparation/certification and licensure of practitioners and maintaining records of each.
- Certification of other practitioners such as Rad Techs and nurses and MA’s as required by the state and if there are standards required by the facility different from state requirements.
- Referral Policies and documentation of how they are managed.
- CME-required hours and records of completion
- Supervision of Ancillary staff who is responsible for training and supervision
- Emergency Care Procedures PALS, ACLS, EMS and transport issues
- Chart reviews Documentation of ongoing quality assurance
- Continuity of Care practices is there a relationship with local pcp and hospitals to provide follow up?
- QI activities Documentation of involvement
- Medication and dispensing are medications given and/or dispensed and what procedures in place to log and monitor giving? EMR has MAR for meds given on site.
- ECG and X-Ray over reading policies Is there arrangement for overreads to assure quality is maintained. Can be flexible here.
- Cleanliness Housekeeping etc.
- Safety-falls, needle sticks, splashes, etc. Both employee and patient considerations
- Laboratory and Radiology Practices Training COLA, CLIA etc.
- Infection Control Hand washing, gloves masks, flu vaccine policy.
- Patients rights HIPPA
- Organization and maintenance of medical records- Owner of records and how stored and archived
- Medical Devices and Equipment-Maintenance and quality control
- Human Resources/Employee Records-Pay, hiring protocols, disciplinary issues, separation issues, benefits, etc.
Below are some bulleted points on JCAHO and ambulatory centers.
- Environment of Care-How safe, functional and effective environment is
- Emergency Management- Ensures disaster plan
- Infection Control- Identifies and reduces risk of acquiring or transmitting Infections
- Information Management- How well center obtains manages and uses information
- Leadership- Reviews structure and relationships of leadership, culture of safety, quality, operational performance
- Medication Management- All aspects of use storage, ordering etc.
- National Patient Safety Goals- prevention of medical errors in ambulatory care
- Provision of Care- Four basic areas: planning care, implementing care, special conditions, discharge an transfer
- Performance Improvement- Focus on using data to manage performance, compiling, analyzing, identifying areas for improvement and implementing improvement.
- Record of Care- Addresses clinical records, authentication processes, timeliness & record retention
- Rights of Individual- Consent, participation in decision making, HIPPPA
- Waived Testing- For CLIA policies and procedures for performing and supervising waived testing
The following areas are generally part of the accreditation process and each is broken down into its working parts in UCAOA and other accrediting bodies. I present them for discussion and consideration.
- Human Resources
- Patient Care Processes
- Physical Environment
- Quality Improvement
- Health Record Management
- Patient Privacy/Rights/Responsibilities
- Scope of Care
In what follows below are what we consider basic certification and accreditation requirements for us and it is here that we launch into the final stage of deciding what we as an organization will mean when we certify or accredit a facility or group of facilities.
Considerations for Certification Requirements
- Copy of business license
- Clear signage of care for children and/or adults
- Clear delineation of hours of operation
- Protocols to recognize children in distress
- SPUC membership of at least Medical Director
- Capability of Pediatric phlebotomy
- CLIA/COLA certification posted
- X-ray on site with pediatric protocols for plain film and state inspection utd
- Emergency cart contains pediatric rescue medications and supplies.
- Transfer protocols in place or policy
- Minimum of one provider trained in Pediatrics on site during hours of operation, MD, DO, ARNP, PA
Considerations for Accreditation
- Meets certification requirements except clear signage delineating Pediatric only with age ranges
- Communicates with medical home within 48 hours
- Operates 7 days per week posts hours as well as holiday hours
- Med Director boarded in Pediatrics or PEM
- Patient identifiers and HIPPA policies
- Medical record
- Human Resource processes
- All providers Pediatric trained and obtain 20 CME hours per year.
- All providers PALS certified.
- All staff BLS certified.
- Evidence of quality and safety programs
- On site inspection
- Emergency closures communicated to patients as reasonably possible.