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If you get a visit from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) this year, it’s likely the surveyors will focus more on the continuum of care for an individual patient and less on an assortment of records and departmental issues.
Although the JCAHO’s 2001 survey process hasn’t changed dramatically from past years, "it will focus on individual-centered evaluation," says Charlene Hill, a spokeswoman for the Oakbrook Terrace, IL-based organization. "Rather than looking at care rendered to a variety of patients, [surveyors] will select a patient to follow through the entire system, so they can see the full continuum of care."
That was the case for Boston’s Brigham & Women’s Hospital, which was surveyed in February, notes Christine Collins, CHAM, director of patient access services. "They were much more interested in the continuum of care and the interdisciplinary, and didn’t focus on one department." JCAHO surveyors looked at patient rights’ issues such as advance care directives, asking, for example, how those were followed up on in the nursing units, Collins adds. "They followed a patient from the emergency department (ED) to the room."
Rather than addressing "admitting for admitting’s sake," she says, the surveyors met with all the hospital’s directors to get a broad-based impression of patient care, and gave the directors high marks. "They were impressed with the group, felt that we understood what we were here for, and liked that we didn’t have a script but were very honest and forthright."
The survey team asked "lots of questions about confidentiality," Collins adds. "They were very concerned about making sure privacy and patient confidentiality were a priority" and also wanted to see documentation of patient education and interpreter services, she says.
As expected, the surveyors did make an "off-hours" visit, Collins explains, arriving at the ED in the evening and moving with a patient through the operating room and on to the nursing floor. "It was much more hands-on, out and around" than in previous years, with less time spent talking in rooms. The surveyors questioned different managers on fire doors and evacuation plans, Collins notes. "They checked out oxygen cylinders, and whether equipment was in designated areas and linen carts were kept closed."
Documentation of quality improvement initiatives was another area of interest, she adds, as was staff competency. "They were stopping people for interviews and asking, How do you know your staff are competent, at all levels?’"
Brigham & Women’s was "more than satisfied" with its review process and "delighted to have passed," Collins says. One area of suggested improvement was in providing speedier job reviews for staff, she notes, which was not a surprise at a facility that has been over 100% occupancy for more than a year. "They know we do great things here," Collins adds. "It’s more their style now not to find what’s wrong, but just to point out things you need to improve on."