Quality assessment and clinical research: a collaborative approach

Obtaining physician commitment to and continued involvement in quality assessment activities can be difficult. Some physicians view quality assessment as a bureaucratic morass that fails to improve patient care. However, by combining quality assessment and clinical research, insight into practice patterns can be obtained and physicians might be more likely to express interest in quality assessment issues. We reviewed medical records of patients at our hospital on peritoneal dialysis (PD) to determine the rate of free air found in normal PD patients. This was compared to PD patients with known gastrointestinal perforation; free intra-abdominal air has been described as a sign of gastrointestinal perforation. Documentation of free air and its significance in radiology reports were noted. Fifty-nine of 59 (100%) cases had available radiology reports. Documentation of free air was present in only 5 of 23 (22%) cases, and its significance was noted in the same 5 of 23 (22%). These results were communicated within the hospital, and a subsequent improvement in free-air detection, documentation, and reporting--both oral and written--was noted by the clinical service. The documentation of radiological findings is a frequently used monitor in radiology quality assessment. Our study identified a clinical and documentation problem, quantified the deficiency, and took steps toward improvement while simultaneously performing clinical research. We conclude that quality assessment and clinical research can coexist and serve to improve clinical practice while encouraging physician involvement in quality assessment programs.