Effect of Hospital Accreditation Process in Outcomes of Patients with Acute Coronary Syndrome

Abstract

Background: Hospital accreditation has as goal the standardization of patient care, aiming quality improvement. On 2015, a cardiology reference hospital was evaluated and got level 3 from ONA in care given to Acute Coronary Syndrome (ACS) patients.Objetive: To compare length of stay (LOS) at Coronary Care Unit (CCU) and the total LOS at the hospital of ACS patients before and after ONA 3 accreditation. Other clinical outcomes were also analyzed.Methods: Systematic and prospective registry of admitted ACS patients at CCU, whose population was divided into pre-accreditation (period 1) and post-accreditation (period 2). Descriptive analysis was performed. For statistical analysis the Mann-Whitney test, chi-squared, Fisher's exact test and Multiple Linear Regression were performed. P value was considered statistically significant when < 0,05.Results: 372 patients were admitted with ACS, 186 in period 1, of which 47 (25,3%) with ST segment Elevation Myocardial Infarction (STEMI), and 186 in period 2, of which 70 (37,6%) with STEMI. The mean age was 65,9 years (± 12,2). About the CCU LOS, there was a reduction from 3 (IQR: 2-4) to 2,5 days (IQR: 2-4; p value = 0,088). Regarding the hospital LOS, there was also a reduction from 8 (IQR: 5-12,25) to 6 days (IQR:4-11; p value = 0,004). Analyzing the type of ACS, there was a significant reduction only at the hospital LOS in non-STEMI patients: 8 to 6 days (p value = 0,001). Other hospitalization length of stay and clinical outcomes did not present a significant reduction in the comparison. Conclusion:After the ONA 3 accreditation, there was a reduction of hospital LOS. There were no significant differences in the other outcomes analyzed.

The impact of hospital accreditation on the quality of healthcare: a systematic literature review

“…Several studies consistently indicated a lack of relationship between accreditation and hospital 30-day readmission rate in various contexts [ 21 , 84 , 89 , 90 ], whereas other studies presented contradictory effects on healthcare-associated infections [ 25 , 85 , 91 , 92 ]. However, studies reported a consistently positive impact of accreditation on hospital [ 84 , 86 , 89 , 93 ] and departmental [ 91 , 94 , 95 ] patient length of stay.…”

“…Interestingly, around one third (n = 24) of the included studies examined the impact of hospital accreditation on patient outcomes [8,21,25,[50][51][52][53][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95]. Of these, 75% have been published since 2015 as an obvious response to previous appeals to investigate accreditation effects on clinical outcomes.…”

Evidence on hospital accreditation to leverage its prospects for improvement

“…Interestingly, around one-third (n = 24) of the included studies examined the impact of hospital accreditation on patient outcomes [20,33,38,61,71,90,91,92,[118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133]. Of these, 75% have been published since 2015 as an obvious response to previous appeals to investigate accreditation effects on clinical outcomes.…”

“…Several studies consistently indicated a lack of relationship between accreditation and hospital 30-day readmission rate in various contexts [20,123,127,128], whereas other studies presented contradictory effects on healthcare-associated infections [38,124,129,130]. However, studies reported a consistently positive impact of accreditation on the hospital [33,123,127,131] and departmental [129,132,133] patient length of stay.…”