After one year of surprising some hospitals with random visits by special surveyors, the Joint Commission on Accreditation of Healthcare Organizations is finding that it rarely catches facilities with their standards down.
Except for one early case last August involving a small hospital in Goshen, Ind. (Oct. 18, 1993, p. 3), no hospitals were denied accreditation, according to the JCAHO's report on the first six months' results.
In 37 one-day surveys between July 1 and Dec. 31, 1993, 36 hospitals retained their accreditation status with no need for a follow-up visit. Of those, 12 had to submit a written progress report. No hospitals were put on conditional accreditation, a probationary status.
The JCAHO instituted the random surveys as a measure of extra vigilance in between routine re-accreditation surveys that come every three years. At the time, the commission pointedly played up its intention that the surveys be unannounced.
But since May, the JCAHO has been notifying hospitals in advance. To date, 91 hospitals have been randomly chosen for visits, unannounced or otherwise, a commission spokeswoman said.
Unannounced amid the program's initial hoopla was the fact that half the sample of randomly surveyed facilities were being given 24-hour notice right from the start. The procedure was a test to see if short notice made any difference in the survey outcome, said Gail Weinberger, director of accreditation policy and administration.
As it turned out, eight of the hospitals requiring progress reports got the 24-hour notice, showing there was little likelihood of benefiting from the tipoff, said JCAHO spokeswoman Alice Brown.
"In 24 hours, although you can do things like mop your hallways, there's not a lot you can do to get your ducks in order," she said.
That was one factor in deciding to give notice to all facilities chosen for the random inspections, Ms. Weinberger said. In addition, such notice gave hospitals time to make key staff available, including chief executive officers who often spend time away from the facility, she said.
The JCAHO also ran into trouble trying to make unannounced visits for its home healthcare accreditations, which involved getting consent from individual patients to visit their homes, Ms. Weinberger said.
She said the commission had committed to making the interim-visit procedure the same across all accreditation programs: hospitals, home-care agencies, ambulatory facilities, nursing homes and mental healthcare providers.
The decision to announce inspections a day in advance may not be such a blessing, according to results of follow-up telephone surveys of targeted facilities. Generally, those that received no notice wished they had, but those that were notified in advance wished they hadn't, said Ms. Brown. All it did was elevate anxiety levels in some cases, she said.
But among the unannounced visits was the trip to Goshen (Ind.) General Hospital, which resulted in a recommendation to deny accreditation. That denial is still being appealed, and a decision by a JCAHO review committee is expected by the end of August, Ms. Brown said. Goshen remains accredited during the appeal.