Hospitals are required by the Joint Commission on Accreditation of Health Care Organizations (JCAHO) to establish programs to improve the quality and appropriateness of care. As a guide for health care organizations, the JCAHO has published standards for monitoring and evaluation.1 An effective quality assurance (QA) system should allow hospitals and individuals to determine the level of quality of care they administer. In particular, problems and deficiencies must be detected and corrective measures taken.
The JCAHO has outlined a 10-step QA process.1 These steps are as follows: (1) assign overall responsibility for the QA program; (2) delineate the scope of care the organization, department, or hospital provides; (3) identify important aspects of care; (4) identify clinical indicators that relate to the important aspects of care—an indicator is a "measurable dimension of the quality or appropriateness of an important aspect of patient care"; (5) establish threshold criteria for evaluation