Detroit Medical Center awaits inspections

Detroit Medical Center faces a surprise quality inspection that could happen any time from state and federal regulators, according to officials from the Chicago office of the Centers for Medicare and Medicaid Services and the Michigan Department of Licensing and Regulation.

CMS said last week it has authorized an investigation at Harper University Hospital and Detroit Receiving Hospital in response to recent media reports to determine whether the facilities are in compliance with the agency's conditions of participation. If violations are found, CMS could terminate DMC's participation in Medicare, costing the for-profit hospital millions in revenue. Violations also could trigger hospital accreditation action by the Illinois-based Joint Commission.

In a statement at midafternoon Friday, a DMC spokesperson said in a statement: "The surveyors have not arrived, but we welcome the opportunity to demonstrate the effectiveness of the quality and safety protocols we have in place and how seriously we take them."

The inspection follows a Crain's article last week that raised questions about ongoing infection control and instrument cleaning issues.

The Oct. 8 article cited ongoing problems with surgical instrument cleaning and also outlined a federal investigation into DMC's cardiology program, the use of employed nurses for private doctors and other matters at DMC.

In 2016 and 2017, DMC was cited for multiple infection control infractions by state and federal regulators. DMC later submitted a plan of correction that was accepted by the Centers for Medicare and Medicaid Services. It has since restructured its sterile processing department, including creating a second one at DMC Children's Hospital of Michigan, Crain's has reported.

Last Wednesday, DMC provided a statement to Crain's responding to questions about instrument cleaning.

"Quality control is paramount to the DMC. For surgical care, that includes having appropriate safety protocols in place and multiple checks and balances as part of the preoperative process, which takes place before surgery begins," according to the DMC statement.

Officials with LARA confirmed they are looking into allegations that DMC has had multiple incidents this year with dirty or contaminated instruments reaching operating rooms in at least three adult hospitals. None of the dirty instruments, those with surface blood or bone fragments, was used in any operations, the sources said.

"CMS has authorized an investigation in response to recent media reports related to these facilities. LARA serves as the investigatory arm of CMS in Michigan," said LARA official Pardeep Toor, adding that LARA "encourages all concerned residents, patients, parents and peers to file complaints against licensed health facilities which may allegedly be risking public health, safety or welfare."

The pending inspection from quality regulators is separate from the ongoing federal investigation into DMC related to its cardiology program and use of employed mid-level practitioners to help private doctors with patient rounds, admissions and discharges, Crain's has reported.

While two surgeons told Crain's that instrument cleaning in the adult sterile processing department has improved, there are still occasional problems with dirty, bloody and missing instruments.

One of the problems, said the senior surgeon, is the level of promised investment by DMC in the adult sterile department is less than what staff expected. He said experienced staff have left because of poor morale and pay lower than market rates. Those left have less experience and are overworked.

But he said the number of instrument sets sent back before surgery at DMC because of contamination problems are probably no more than other hospitals.

However, three surgeons expressed ongoing frustration about opening surgical trays and finding that critical instruments are missing. The senior surgeon, who said he has practiced at other hospitals where this is not as great a problem, said he believed it was due to lack of budget to spend on new or replacement instruments as opposed to poor department management.

Multiple sources told Crain's other problems DMC's operating rooms, mainly at Harper, Receiving and the orthopedic surgery suite at DMC Cardiovascular Center, involve the following:

• Missing instruments in surgical trays, which sources say happen every week.
• The time it takes — 20-30 minutes — to receive a new tray or instrument from the central sterile processing department because of the distance from cleaning rooms to ORs at Harper, Receiving and the Heart Hospital. Surgical teams and patients under anesthesia sometimes have to wait, increasing costs and possibly creating quality issues.
• Transporting sterile trays and instruments through DMC corridors to hospital ORs sometimes causes wrappings of trays to be punctured, causing potential contamination and exposure. In those cases, which happens regularly, the trays cannot be used and must be reordered by surgical staff, delaying surgical teams and patients.

"Detroit Medical Center awaits inspections" originally appeared in Crain's Detroit Business.