The Joint Commission on Accreditation of Healthcare Organizations has suspended a short-lived requirement that accredited hospitals put in place patient safeguards recommended in special clinical alerts issued by the private accrediting agency.
Recognizing that the alerts and their safety requirements are putting too much of a burden on hospitals, the JCAHO instead will develop a short list of patient-safety risks that require attention by accredited hospitals.
"It's a classic problem, and we created it all by ourselves," said JCAHO President Dennis O'Leary, M.D.
Sitting on information about patterns of medical mistakes and eager to get results, the JCAHO pumped out the alerts without considering the implications of requiring monthly responses from the field and the burden to providers of implementing them.
"It's a little like trying to drink water from a fire hydrant," O'Leary said.
The JCAHO will decide on about a half-dozen sentinel events to include in accreditation scoring each year, chosen for their importance and the evidence base to support recommended preventive measures, he said.
Since 1998, the JCAHO has published 20 alerts arising from its ongoing collection of information on sentinel events, in which preventable mistakes cause serious harm to patients (See related story, this page).
What began as dispatches of advice for recognizing and preventing such incidents eventually hardened into requirements for healthcare organizations to implement the recommendations contained in each alert-or reasonable alternatives-within 90 days of publication by the JCAHO. The use of alerts in accreditation scoring began in September.
For facilities preparing for a survey, the result was an imposing workload devoted not only to addressing several years of alerts but fielding additional alerts that had escalated to monthly frequency in 2001 from quarterly publication in previous years, said Susan White, vice president of quality management at the Florida Hospital Association.
White was among members of a commission task force on improving accreditation who expressed concern about using the alerts in accreditation scoring. Besides their proliferation, the alerts were not specific about what surveyors required in implementing them because they were written to be educational, not prescriptive, she said.
The commission on Oct. 29 declared a moratorium on using alerts in the scoring. Instead of making providers responsible for all previous and future alerts in the accreditation process, the JCAHO is planning to identify about six patient-safety priorities from a pool of specific recommendations and focus on them in surveys, O'Leary said. Surveyors will be looking for compliance with those targeted recommendations, and the results also will be included in the performance reports available to consumers, he said.
A group of eight to 10 experts in patient safety and clinical-performance improvement will decide what priorities to include in accreditation. No experts have been approached yet to serve on the panel, which should be in place by early next year, O'Leary said.
The JCAHO will continue with bimonthly sentinel-event alerts in 2002, an output O'Leary said is "not a fire hydrant but a good, aggressive faucet."