Bring in the Vikings!

Photo by Panoramas on Flickr

If you can possibly avoid it, don’t have elective surgery in any hospital when Joint Commission surveyors are on site, supposedly guarding your best interests.  Trust me: all your medical documentation will receive exquisite attention.  It’s less certain that the staff will be paying much attention to you.

My hospital had its long-awaited Joint Commission review last week.  We were in a state of high paranoia.  After all, we’re the hospital that famously overdosed an Dennis Quaid’s premature twins with heparin, and over the years we’ve had a few of those pesky retained objects during surgery.  So we couldn’t afford another major “oops”.

My department was determined not to be the weakest link.  To that end, half a dozen senior partners were assigned no cases, and instead were paid to patrol the halls and operating rooms looking for violations of Joint Commission standards.  These rules have become so trivialized that they defy common sense.

If an anesthesiologist draws up medications and labels the syringes first thing in the morning for his own case, what is the point of having to write the date, time, and his initials on the medication labels?  That’s a nuisance and a distraction from more important considerations about the case.

No one could keep the rules straight about how to handle multi-dose and single dose vials of medications.   Date and time it today?  Or for when it expires, four weeks from today?  If in doubt, throw it out.  We decided that we weren’t going to solve the drug shortage problem; we just needed to get through the survey.  I can only imagine how many thousands of dollars we spent throwing away perfectly good medications.

The ASA has tried to inject some common sense into the issue of locking anesthesia carts within the ORs, but as far as I can tell there’s been no change in the rule.  Part of my job as one of the hall monitors was to make sure the anesthesia cart was locked each time the anesthesiologist left the room.   In one instance, the combination lock jammed and the anesthesia tech had to use a hammer to get it open.  It’s a good thing the next patient didn’t need any urgent anesthesia care.

Worse yet, a directive came down from above to lock the anesthesia workroom while the surveyors were on site.  This room is within the central OR core, which is accessible only by ID badge.  It contains the difficult airway cart, tube exchangers, and other equipment that may be needed immediately in a critical situation.  This time we balked and refused to lock the workroom.  Apparently that was acceptable, but what if we had simply caved in to the demand?

If you’ve been through a Joint Commission survey before, you know that every time the surveyors come up with some brand new rule that no one has ever heard of and everyone rushes to implement, no matter how silly it seems.  This time, the surprise rule was that linen hampers in the OR must not be placed within five feet of trash containers.  Really?  And what exactly is supposed to happen if they edge closer together—spontaneous combustion?

There are two pieces of good news.  One is that the surveyors left Friday afternoon, and on Monday we’ll be back to business as usual, paying attention to our patients instead of playing the arbitrary Joint Commission game.  The second is that the Joint Commission is no longer the only option.  For decades, the Joint Commission has been the only agency deemed acceptable by the Centers for Medicare and Medicaid Services (CMS) for hospital accreditation.  Now, however, competitors are springing up.

One that’s worth keeping an eye on is DNV.  No, I don’t mean the Department of Motor Vehicles.  Det Norske Veritas is an independent foundation “with the purpose of safeguarding life, property, and the environment”.  Its history dates back to 1864, when the company was established in Norway to inspect and evaluate the technical condition of Norwegian merchant vessels, and it had U.S. offices decades before the Joint Commission existed.  Now DNV has expanded into the business of managing risk and improving quality in all kinds of businesses including healthcare.  Two years ago, DNV was granted authority by CMS to accredit American hospitals, and it’s acquiring new clients every day who are sick to death of the Joint Commission.

Personally, I’m delighted at the prospect of dealing with a company that might take a fresh look at processes without the Joint Commission’s obsessive faultfinding. Free-market competition between accrediting agencies may be the best thing that’s happened to hospitals in quite some time.  Bring in the Vikings!  It’s hard to believe they could be any worse than what we’ve been dealing with up to now.



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