Recently, the online version of JAMA published an original investigation titled, “Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.” The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care.
The authors found that there was aadmitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks, a 5.9% relative decrease. The positive effects of being monitored have been well documented in all kinds of arenas, such as hand washing and antibiotic stewardship. But mortality?
This is an interesting outcome, especially considering a recent ordeal I went through with my dear sister-in-law. She was on vacation in a somewhat remote location and suffers from a chronic illness that requires her to have a tunneled line through which she receives nocturnal TPN. She presented with high fever and rigors, septic, with a Klebsiella bacteremia. Though I was reassured somewhat by the words “sepsis protocol” used by the hospital staff, I was utterly dismayed when the hospitalist continued to use her line, even though the culture from the line was positive and she continued to spike fevers and develop rigors whenever the line was accessed.
Overall, I feel like I’m a reasonable person, but the clear lack of interest – or willingness to consider that this might not be a good idea on the part of the hospitalist in charge – incited a certain amount of anger and disbelief in me. She also received an antibiotic that she had a documented allergy to – a clear medical error. I instructed my sis-in-law to refuse access to the line; it was removed, and she ultimately recovered to discharge.
This brings me back to the JAMA study. It’s easy to perceive unannounced inspections as merely an inconvenience, where things are locked up that normally aren’t, or where that coveted cup of coffee you normally bring on rounds to get you through your day is summarily yanked out of your hand.
Read theat hospitalleader.org.
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by Brad Flansbaum, DO, MPH, MHM by Leslie Flores, MHA by Anne Sheehy, MD, MS, FHM