Risky Business
Errors are typically the result of the ___________, not the people.
System
This is the evaluation of medical necessity, appropriateness, and efficiency of care.
Utilization review
This group has the ultimate authority over the quality of care of a healthcare organization
Governing body/board
Shows the relationship of the parts to the whole
Pie chart
The average time it takes to fulfill ROI requests
Process indicator
An event that results in significant harm or death.
Sentinel event
This type of review occurs after discharge
Retrospective review
These govern the practice of medical staff members
Medical staff bylaws (bylaws)
Tracks the frequency of one or more variables over time.
Line chart
The rate of background checks completed before hire.
Structure indicator
An event that results in, or is perceived to result in personal injury or loss of property.
Potentially compensable event
A continued stay review falls under which type of review?
Concurrent
This is the process of assessing and validating the qualifications of physicians and other LIPs.
Credentialing
Shows whether or not a process is in control
Control chart (or run chart)
The post-op infection rate for Dr. Stitcher.
Outcome indicator
Joint Commission requires this to be conducted following an event that results in significant harm or death.
RCA (Root Cause Analysis)
This function of UM involves coordinating care.
Case management
This is the process of evaluating an individual's performance by someone with similar credentials, training, and skills
Peer Review
Shows a correlation (or not) between two variables.
Scatter (or plot) diagram
The employee rating of organizational safety.
Structure indicator
The health record is considered this in a court case.
This planning might actually begin before or upon admission.
Discharge planning
This type of review is performed when a physician's case review shows they have exceeded acceptable thresholds.
FPPE - Focused Professional Practice Evaluation
Puts the 80/20 rule into perspective
Pareto chart
The re-admission rate for DRG 428
Outcome indicator