Ohio Admin. Code 3701-84-85 - Quality assessment and performance improvement - pediatric cardiovascular surgery service

In addition to the general quality assessment and performance improvement requirements set forth in rule 3701-84-12 of the Administrative Code, each provider of an open heart pediatric cardiovascular surgery service shall will:

(A) As part of the service's overall quality assessment and performance improvement process:

(1) Utilize the quality performance measures outcomes data obtained from the service's participation in the service's chosen data registry the society for thoracic surgeons congenital heart surgery database; and

(2) Include a periodic review and evaluation of the multidisciplinary meetings required by paragraph (D) of rule 3701-84-81 of the Administrative Code.

(B) Have a regular formal morbidity and mortality conference chaired by the medical director of the open heart pediatric cardiovascular surgery service or the medical director's designee. The morbidity and mortality conferences shall will:

(1) Be held at a minimum, once a month or more frequently depending on the need; and

(2) Review all deaths and complications such as reoperation for bleeding, deep sternal wound infection, stroke, and perioperative myocardial infarction, and any patterns that might indicate a problem shall will be investigated and remedied if necessary.

Notes

Ohio Admin. Code 3701-84-85

Effective: 5/15/2023
Five Year Review (FYR) Dates: 2/27/2023 and 05/05/2028
Promulgated Under: 119.03
Statutory Authority: 3702.11, 3702.13
Rule Amplifies: 3702.11, 3702.12, 3702.13, 3702.14, 3702.141, 3702.15, 3702.16, 3702.18, 3702.19, 3702.20
Prior Effective Dates: 03/01/1997, 03/24/2003, 06/21/2012, 08/01/2017