Anyone who has spent time in the military knows that when someone utters the phrase, "We're here to help you", it means the IG has come to town to see what's hidden under all the rocks. It is understood they don't really mean what they say...after all, their job is to find things that can be blamed on the local commander and his staff. And they will find something.
In the world of civilian medicine, the counterpart of the IG is The Joint Commission. This is a private organization which has attained near mythic powers over the decades of its existence. Without its blessing and the small wall plaque which comes with successfully completing a survey, hospitals are severely limited in participation in Medicare and other government programs. Every three years, a small group appears without warning and throws the hospital into panic. Every aspect of the care provided to patients is scrutinized and compared against both TJC's constantly changing standards and the hospital's own policies and procedures.
Last week was our turn, with three surveyors appearing one morning at our front door. One was focused strictly on the physical structure and whether it was safe for patients and staff. One dedicated three days to looking at the Home Health and Hospice which are associated with the hospital. And the third was a nursing surveyor who was interested in everything. She wandered from the Emergency Room, through Radiology, to inpatient nursing areas. She talked with staff members, questioning how they took care of their patients. Documentation of that care was reviewed to see if it matched the staff's explanations as well as the hospital's policies and procedures. Patients were interviewed to find out what they knew about their own care and what was being planned for them. Personnel files were pulled to see if staff had documentation that they were competent to take care of the patients assigned to them.
Finally, she arrived at the most important part of the entire survey...the Operating Room! Okay, so maybe I'm slightly biased since it's mine, but it is still one of the core areas which incorporates all aspects of caring for the patient. How do you know your surgical instruments are really sterile? Do medications get labelled as they are placed on the sterile field? How are implants tracked? Are surgical sites always marked preoperatively by the surgeon to verify it is correct? What is the process for identifying your patient and the surgery to be performed? In the Recovery Room, how is pain assessed, and how is it documented? Throughout the surgical experience, is the patient's medical information kept safe and private? All these topics and more were raised, discussed and responses evaluated.
After three days of walking on eggshells, it was finally over. We survived as a hospital, once again making it through with no major problems. Of course, they did find some things, since that is their job. These opportunities for improvement will be studied, plans of correction drawn up and implemented, results evaluated and forwarded to the Joint. After a week or two of relaxing and recuperating, the cycle begins all over again. The job of making sure our patients are safe never ends. Three years isn't very long when you are preparing for your next survey.
Did I mention that we get to pay for the privilege of being examined by The Joint Commission?
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