Established in 1986, the mission of the Voluntary Review of Quality of Care (VRQC) Program is to provide peer consultations to departments of obstetrics and gynecology, assess the quality of care provided, and suggest possible alternative actions for improvement. This is accomplished by way of a site visit conducted by three board-certified, practicing obstetrician-gynecologists and a nurse with experience in obstetrics and gynecology, utilizing various quality assessment techniques, including an evaluation based on the American College of Obstetricians and Gynecologists (the College) guidelines.
The VRQC Program offers comprehensive, department-wide reviews focusing on all practitioners with obstetric-gynecologic privileges (unless staff size is prohibitive), although reviews may be limited to obstetrics or gynecology, if requested.
Following a request for a site visit, the hospital will be asked to submit demographic and clinical data to provide a profile of the hospital, and more specifically, the obstetrics and gynecology department. A deposit of $10,000 is payable at the time of application. If, within 30 days of receipt in the American Congress of Obstetricians and Gynecologists (ACOG) office, the hospital withdraws its request, ACOG will retain $500 of the deposit for administrative costs and will return the balance to the hospital. The hospital will also be asked to sign an Agreement to Conduct a Voluntary Review of Quality of Care, which addresses provisions of the Health Insurance Portability and Accountability Act (HIPAA). In the Agreement, the hospital will be also be asked to indemnify and hold harmless the reviewers, the Committee on Patient Safety and Quality Improvement, and the College, and ACOG.
Reviewers are selected from the VRQC Reviewer Panel, composed of ACOG Fellows experienced in peer review/quality assessment techniques, board-certified physicians in other specialties (ie, anesthesiologists, family physicians, certified nurse-midwives) and nurses specializing in obstetrics. The hospital will be given the opportunity, before the site visit, to review credentials of the reviewers chosen.
All efforts will be made to schedule a site visit within 60 days of submission of all requested data. The review team will usually spend Thursday evening through Sunday morning on-site and will examine specified types of medical charts and issues identified by the hospital and through an analysis of the data submitted. The review team will also interview various members of the administration, clinical staff, and executive board. All information discovered during the interview process will remain anonymous.
Hospital authorities will be asked to designate a coordinator for the site review. This person will be responsible for communicating with the review team, scheduling the required interviews, ensuring that materials needed by the reviewers are available both before and during the site visit, assisting in a tour of the facility, and securing a work space for reviewer use during the site visit. The review team will evaluate services and examine the scope of medical care within obstetrics and gynecology. The review team may also focus on specific issues brought to its attention by responsible hospital authorities before the site visit, dependent upon the focus of the review requested.
Entrance Conference (Day One)
The entrance conference is held on the first day on-site. Invitees should include a member of the governing board, the chief executive officer, chiefs of the medical staff and the department of obstetrics and gynecology, the hospital coordinator, and individuals scheduled to be interviewed. However, other individuals, including all members of the department of obstetrics and gynecology, may participate at the discretion of the hospital. The conference should include a hospital representative from nursing. The content of this meeting usually includes introduction of team members, a brief history of the VRQC program, clarification of the issues prompting the visit, and agreement on the visit schedule. There will be adequate time to discuss any questions posed by hospital personnel about the site visit.
Facility Tour (Day One)
The tour of the facility is conducted in conjunction with the entrance conference. The tour helps the team to assess the physical resources of the institution and supplements the information from the preliminary data and the entrance conference.
Interviews (Day Two)
Interviews are conducted with medical staff and key members of hospital administration. They typically are scheduled for 30 minutes per person. Information gleaned from the interview process is kept anonymous.
Review of Medical Records (Day Three)
Chart review enables the team to objectively evaluate care given by the hospital staff over a period of time and under varying circumstances. The Review Team evaluates and rates about 70 patient charts. Approximately 60 of the charts are randomly selected for procedures such as induction of labor, cesarean delivery for nonreassuring fetal status, hysterectomy for abnormal uterine bleeding, etc. The remaining 10 charts are selected by the hospital for specific concerns.
The review process is enhanced by team members’ use of standardized worksheets for each chart. Ratings for charts are defined as Satisfactory, Unsatisfactory Documentation, Unsatisfactory Management, or Unsatisfactory Documentation and Management. The hospital should arrange for a representative from Medical Records to be available at all times to assist the team, as necessary.
Exit Conference (Day Four)
The review team will discuss the general findings and the types of recommendations that will be included in the final report. Attendees will generally be the same as for the entrance conference.
After the visit a confidential final report will be prepared that will analyze available data and present the Review Team’s findings and recommendations based on the College’s guidelines. The final report is mailed to the hospital upon receipt of the balance due by the hospital. The hospital report is delivered approximately 8 weeks after the site visit date.
The hospital may not use any portion of the report or references to the VRQC review for promotional purposes. It is the responsibility of the hospital to determine which of the recommended actions would be appropriate and desirable for the hospital to implement. It should be understood that no accreditation is conferred by this process. The report is sent to a single individual designated by the hospital. The report is the property of the hospital and may be shared with other individuals on an as needed basis.
Following receipt of the final report, hospital staff will be asked to evaluate the process and results of the review. Six months later, a final questionnaire will be sent asking about the review’s impact on obstetric and gynecologic care.
A total fee of $55,000 for a review taking place in 2015 is inclusive of travel, lodging, and meals for a 5-person review team, as well as remuneration for the team members and a portion of the administrative costs necessary for maintaining the program. Additional reviewers may be added to the team for an additional cost of $5,000 per reviewer. Fees may be subject to change.
The VRQC Program brochure contains more details about the process. If you would like to learn more about the program, contact the VRQC Manager at firstname.lastname@example.org or call (800) 266-8043.