Accreditation as a Tool for Quality Assessment and Management in Hyperbaric Medicine

Introduction and relevance

Quality, safety and effectiveness are fundamental health-system objectives. Hyperbaric medicine presents additional quality-management challenges because treatment involves specialised pressure systems, oxygen-rich environments, dedicated equipment, staff training requirements and risks affecting both patients and personnel.

The paper analyses accreditation as an independent external assessment mechanism that compares actual organisational practice with predefined standards and can support systematic quality and safety management.

Aim

To examine the principal characteristics of accreditation as a quality-assessment tool and evaluate its relevance to hyperbaric oxygen therapy in international and Bulgarian settings.

Materials and methods

The study reviews scientific publications, specialised literature, regulations, standards, recommendations and reports issued by organisations involved in accreditation and quality management in hyperbaric medicine.

Quality-assessment logic

Quality assessment is described as a sequential process: define the purpose, object and scope; select criteria; specify indicators and measures; collect and analyse information; decide on improvement actions; and monitor implementation.

A typical accreditation pathway includes an organisational decision to apply, self-assessment, formal application, external on-site survey, expert reporting and a final accreditation decision.

International accreditation models

In the United States, accreditation is voluntary but widely used. The Undersea and Hyperbaric Medical Society (UHMS) operates a specific accreditation programme for hyperbaric facilities, and the paper reports more than 180 accredited centres in the period reviewed. The model distinguishes three levels: hospital-based centres with 24/7 activity and emergency/intensive-care capability; outpatient centres linked to hospitals; and freestanding outpatient centres.

In Canada, accreditation is mandatory for some hyperbaric facilities and is linked to national standards and professional oversight. Australia applies specific standards to hospital and private hyperbaric services, including training and qualification requirements. In Europe, accreditation may be mandatory or voluntary; the European College of Baromedicine functions as a specialised accreditation body, and by 2020 the reviewed training-accreditation scheme included eight accredited centres — seven in Europe and one in Australia.

Bulgarian regulatory context

Accreditation was introduced in Bulgaria as a mandatory procedure for hospitals and diagnostic-consultative centres in 2000. Following amendments to the Medical Establishments Act in 2010, it became voluntary except for structures involved in undergraduate and postgraduate training.

Ordinance No. 18/2005 regulated organisational structure, equipment and staff qualification but was repealed in 2019 and replaced by Ordinance No. 8 concerning institutions that train students and specialists.

The central gap is the absence of a dedicated regulatory and accreditation framework for hyperbaric centres despite the increasing number of hyperbaric chambers and the need for uniform standards governing equipment, safety, professional competence and clinical practice.

Duration and organisational effects

Across the countries reviewed, accreditation algorithms are broadly similar, while the validity of accreditation decisions typically ranges from two to five years.

Accreditation is associated with implementation of safety standards and protocols, stronger organisational climate, improved staff competence and motivation, higher patient satisfaction and a better institutional image. Its value therefore extends beyond external certification to internal quality-management development.

Main contributions

• compares international hyperbaric accreditation models with Bulgarian regulation;
• identifies a clear national gap in dedicated accreditation for hyperbaric services;
• shows that general healthcare regulation is insufficient where equipment, safety, staff competence and clinical protocols are highly specialised;
• supports development of a national standard for hyperbaric oxygen treatment aligned with European and international norms;
• positions accreditation as part of continuous quality and safety management rather than a stand-alone external inspection.

Conclusions

Accreditation can be a robust instrument for quality assessment and management in hyperbaric medicine when it is based on discipline-specific professional standards and independent external review.

For Bulgaria, the priority is a specialised regulatory and standardisation framework capable of ensuring competent staff, reliable equipment and safe therapeutic services and of providing a credible basis for a dedicated accreditation system.

Scientific Key Terms