[Clinical practices appraisal in the second certification process of French healthcare organisations]

Second certification process of healthcare organisations (V2) has a main challenge: clinical care improvement through strengthening of clinical practices appraisal (CPA). The approach is based on standards focused on CPA. Besides a specified policy devoted to clinical practices appraisal (Table 1 - standard 6c), CPA in V2 has 3 key objectives: appropriateness of hospitalization and acts, a priori and a posteriori management of healthcare-related risk and clinical practices related to specific diseases. First results show that issues the more evaluated by healthcare organisations are appropriateness of antibiotics and anti-thrombosis orders (Table 1 - 44c), safety in medication management, urinary catheterization and seclusion (Table 1 - 45a), adverse events such as falls and bedsores (Table 1 - 45b). Regarding diseases (Table 1 - 46), cancer, coronary disease, stroke and diabetes are the more evaluated in medicine, cancer, antibiotic prophylaxis and hip prosthesis in surgery, delivery and cesarean section in obstetrics, suicide in psychiatry, pain and nutrition in long term care or readaptation. CPA in V2 is in tune with current French law context which makes mandatory individual CPA and continuous medical training, while physicians'accreditation of at-risk specialties is a voluntary process.