- Fewer patients die during weeks when hospital inspectors are conducting unannounced visits, a new study in JAMA Internal Medicine shows.
- According to Harvard University researchers, 30-day mortality for patients admitted during inspection weeks was 7.03%, down from 7.21% during nonsurvey weeks. The biggest impact was seen at large teaching hospitals, where heightened vigilance, if applied yearlong, could cut patient deaths by 3,600.
- “The results suggest there are opportunities for quality improvement right under our noses that we take for granted,” the study’s lead author, Michael L. Barnett, an assistant professor of healthcare policy management at the Harvard T.H. Chan School of Public Health, told Stat. “Some creative thinking around how we react to Joint Commission surveys might lead to quality improvement.”
The study, published online Monday, analyzed outcomes for 1.7 million Medicare patients at 1,984 hospitals between 2008 and 2012 and compared 30-day mortality during weeks when The Joint Commission conducted an unscheduled inspection and the three weeks before and after those visits. The researchers also looked at rates of Clostridium difficile (C. diff) infections, in-hospital cardiac arrest mortality and patent safety indicators.
The impact on mortality was most pronounced at major teaching hospitals, where rates dropped from 6.41% to 5.93% during survey weeks. No change in secondary outcomes was observed, the study says.
Hospital-acquired infections are a major concern for health systems. A recent Consumer Reports evaluation of 3,100 hospitals showed that about one-third received poor scores because of an inability to control C. diff infection rates. Such problems can affect a hospital's bottom line. The CMS imposed a financial penalty last year on more than 750 hospitals because of poor infection control.
The Joint Commission conducts unannounced on-site surveys every 18 to 36 months at U.S. hospitals, and a poor score could mean loss of accreditation or a citation. Either can damage a hospital’s reputation and portend possible closure. Teaching hospitals are particularly reliant on their reputations to attract top-level staff and financial support for research and other programs.
Rather than replicate the stress of inspection weeks throughout the year, the researchers say hospitals should view Joint Commission surveys “as a window into quality improvement that is likely driven by a small number of key changes during surveys.”
They note, for example, that heightened scrutiny could increase awareness of operational deficiencies in areas like paper documentation and hand hygiene and infection control protocols, leading to improved patient safety. Hospital staff are also less likely to let themselves be distracted from patient care when inspectors are present, the study notes.
“One strategy for health systems to consider would be to observe which aspects of normal day-to-day operations change most dramatically in their institution to meet survey readiness standards (eg, clean environment and proper documentation),” the authors write. “Those changes may be the best opportunities to identify whether more continual attention could improve patient safety.”