When Hospital Inspectors Are Watching, Fewer Patients Die

This probably has more to do with administrators properly staffing the hospital as soon as word comes that the Joint Commission is present.

Its sad that this article doesn't even mention this. At least almost all the comments have made this issue painfully present.

An unreplicated study requires further study before being accepted as fact.

I hope this study will be refuted by a following one. Before ny retirement, in the weeks leading to a Joint Cmmission visit to the hospital, I used to quip that we were spending more time doctoring the records than the time spent treating the patients, (this observation too still seeks proof).

Of course everyone makes this sound like the doctors and other medical staff are being more diligent when being watched. The truth of the matter is that it's the hospital administration that needs watching- they ramp up staffing during these so-called "unannounced" visits practically instantly by bringing in on-call nursing staff. And trust me, they are send them home the minute the observers have left the building!

No mystery here. The hospitals staff up before JCAHO visits. While they don't know the exact day of the inspection, they know when they at due and a big push starts to get everyone "up to speed". They also staff to where they are supposed to be, so morale is better and the nurses are not pulling the inspectors aside to let them know what is really going on.

I have been a hospital critical care nurse for 38 years, and have been through innumerable JCAHO and state health department inspections. It is a game that gets played every two years. Nursing staff levels matter. It is the difference between someone actually looking at your lab work and taking action, or ignoring the results. It is the difference between changing the blood soaked dressing or just "reinforcing" the dressing. It is the difference between some one actually watching the cardiac monitor and taking action before you arrest, versus a full on code.

Stories/research papers like this are mis-leading in that it doesn't ask, or at least, doesn't tell which patient populations are the deaths being averted. It could be that death rates fall because stricter adherence to admit/discharge protocols are maintained so there are few people dying in hospital and more dying at home.

Then the journalist only lists one of the possible explanations offered by the physician they interviewed (I am certain that the doc in question listed a number of possible explanations) in a way that sounds like it's the only one possible conclusion: The health care profession is negligent unless you're constantly cracking the whip over them.

That's a nice idea, but I assure you when a surveyor enters the building everyone from the OR to the ICU knows in a matter of minutes. Riskier procedures might be delayed and staffing increased during inspection times, which probably explains these numbers. I am frequently called in to "staff up" during inspections times. Translation? Perhaps staffing levels should be increased all of the time to decrease patient mortality. Oh wait, money.

Combined with nosocomial infections, this is an indictment of hospital administration and the utter lack of attention to detail. One should not add significantly to the risk of terminating one's life by going to a hospital.

I am surprised to learn that the Joint Commission's inspections are unannounced. When my wife worked for 40 years in hospitals she always knew two months before that an inspection team was coming.

An inescapable fact is that the competent investigation of every harmful event reveals that the causation of the harm includes the mistaken/ naïve/ unwarranted/ gullible/ imprudent trust and confidence in one or more erroneous/ untrustworthy theories, assumptions, standards, devices , procedures, processes, programs, people, institutions , agencies, contractors , and/or conditions. The functional alternatives include monitoring, curiosity, skepticism, and the “questioning attitude.”

Quotation: “You get what you inspect; not what you expect.”-An old U.S. Navy proverb

Quotation: “Trust, but verify.”-Quoted by President Ronald Reagan

This study offers more evidence for the vital need for robust systems to monitor and measure provider outcomes, and to make the results transparent to a third party -- ideally to patients, payers, and potential future consumers. Accountability for one's results in healthcare should not be optional.

Do we need "studies" for the more than obvious fact that "when the inspectors are watching, fewer people die"?

It is an excellent question and a warranted brute force approach to ask whether doctors and nurses are better when they are more closely supervised and I actually expected full percentages in differences. However, 0.39% isn't much to defend statistically, and the age differences of 72.84 vs 72.76 (supervised) years might play into that, "mortality adjusted" or not. Most importantly, "We observed no significant differences in admission volume, length of stay, or secondary outcomes." Secondary outcomes being: "Clostridium difficile infections, in-hospital cardiac arrest mortality, and Patient Safety Indicators (PSI) 90 and PSI 4 measure events." Shoddy work would most certainly increase infections etc. I for one am relieved. Well done, generally, doctors and nurses!

As someone that worked in hospitals, we knew that Joint Commission was "coming soon" because nearby hospitals would inform each other when any one was being inspected. And yes, facilities would go into preparation mode instead of being ready for an inspection at any time. The statistics in this article indicate that hospitals need truly unannounced inspections to better insure uncertainty.

The Joint Commision doesn't just monitor doctors.