Patient mortality during unannounced accreditation surveys at US hospitals.
Approach to Improving Safety
Setting of Care
Prior research has demonstrated that hospital accreditation by The Joint Commission is associated with improved hospital performance on certain quality of care measures. However, it has not been established whether the survey periods themselves are associated with a change in patient outcomes. Researchers analyzed Medicare admissions at 1984 hospitals surveyed by The Joint Commission between 2008 and 2012 from 3 weeks prior to a survey up to 3 weeks afterward. They compared patient outcomes between survey periods and the surrounding weeks. For the primary outcome—30-day mortality—patients admitted to the hospital during survey periods had significantly lower mortality than those admitted during nonsurvey weeks. The authors conclude that heightened vigilance during survey weeks and resultant changes in practice may explain this finding. This interpretation captured much attention and calls for making heightened vigilance a year-round phenomenon. The study reported detectable reductions in mortality essentially as soon as the survey week begins and reverts to previsit levels when it ends. It seems unlikely that hospitals across the country can increase the numbers of personnel available for patient care and that the teams would work so well together nearly instantaneously. By contrast, it seems plausible that hospitals could cancel or postpone risky elective procedures on a dime, and immediately resume scheduling such procedures after the week ends. Since emergent care continues as usual, there is no increase in avoidable mortality, but the postponement of elective procedures means that some deaths are averted. A past PSNet interview with the president of The Joint Commission discussed his role in the organization.