Joint Commission Accreditation Research Articles

Exploring COVID-19 census burdens by US hospital characteristics: Implications of quality reporting at rural and critical access hospitals.

By assessing longitudinal associations between COVID-19 census burdens and hospital characteristics, such as bed size and critical access status, we can explore whether pandemic-era hospital quality benchmarking requires risk-adjustment or stratification for hospital-level characteristics. We used hospital-level data from the US Department of Health and Human Services including weekly total hospital and COVID-19 censuses from August 2020 to August 2023 and the 2021 American Hospital Association survey. We calculated weekly percentages of total adult hospital beds containing COVID-19 patients. We then calculated the number of weeks each hospital spent at Extreme (≥20% of beds occupied by COVID-19 patients), High (10%-19%), Moderate (5%-9%), and Low (<5%) COVID-19 stress. We assessed longitudinal hospital-level COVID-19 stress, stratified by 15 hospital characteristics including joint commission accreditation, bed size, teaching status, critical access hospital status, and core-based statistical area (CBSA) rurality. Among n = 2582 US hospitals, the median(IQR) weekly percentage of hospital capacity occupied by COVID-19 patients was 6.7%(3.6%-13.0%). 80,268/213,383 (38%) hospital-weeks experienced Low COVID-19 census stress, 28% Moderate stress, 22% High stress, and 12% Extreme stress. COVID-19 census burdens were similar across most hospital characteristics, but were significantly greater for critical access hospitals. US hospitals experienced similar COVID-19 census burdens across multiple institutional characteristics. Evidence-based inclusion of pandemic-era outcomes in hospital quality reporting may not require significant hospital-level risk-adjustment or stratification, with the exception of rural or critical access hospitals, which experienced differentially greater COVID-19 census burdens and may merit hospital-level risk-adjustment considerations.

Consistency and Sustainability of Home Health Agency Patient Experience Star Rating Performance and the Association With Joint Commission Accreditation

Accreditation seeks to improve the quality of health care, 1 dimension of which is patient experience. The Home Health Consumer Assessment of Healthcare Practitioners and Systems (HHCAHPS) survey collects patient care experience data in home health agencies (HHAs). This study examined the association between accreditation and the consistency and sustainability of high patient experience ratings between Joint Commission (TJC)-accredited and non-TJC accredited HHAs. This multi-year observational study analyzed HHCAHPS star rating performance data from 2015 to 2019. The 5 measures included are based on the 3 publicly reported composite measures, the global measure, and a Star Summary measure. Each measure receives a star rating from 1 to 5. A total of 7230 HHAs reported star rating data between 2015 and 2019, with 4099 (56.7%) having data spanning all 5 years. Of these, 959 (23.4%) were TJC-accredited and 3140 (76.6%) were not. A star rating score of 4 or 5 was considered high performing. TJC-accredited (vs non-TJC accredited) organizations had a higher proportion of HHAs with all 5 years with a high rating ( p &lt; .05 for all measures). Among those HHAs who were in the top rating category the previous year, TJC-accredited (vs non-TJC accredited) HHAs had an even higher probability of sustaining the top rating category in the current year ( p &lt; .001 for all measures). These findings suggest that TJC accreditation is associated with consistently high HHCAHPS star ratings over time. This association was strongest for the Specific Care Issues measure where the concepts addressed by the measure overlapped with topics addressed by accreditation standards.

Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation

BackgroundThis study evaluated the relationship between Joint Commission accreditation and health care–associated infections (HAIs) in long-term care hospitals (LTCHs). MethodsThis observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line–associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic. ResultsThe data set included 244 (73.3%) Joint Commission–accredited and 89 (26.7%) non–Joint Commission–accredited LTCHs. Compared to non–Joint Commission–accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission–accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI). ConclusionAlthough this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission–accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP–related standards as inputs into LTCH policy.

The Relationship Between Patient Experience Special Care Measures and Joint Commission Accreditation Standards Compliance

Accreditation evaluates healthcare organization quality of care and patient safety processes, but the influence of this activity on the patient experience is not well understood. This study was designed to explore the relationship between accreditation survey scoring and patient experience of care using a subset of The Joint Commission (TJC) accreditation standards that are conceptually aligned with the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Special Care Issues composite. This was an observational study that used 2018 to 2019 CMS HHCAHPS data and TJC survey findings for 1464 accredited HHAs. The presence or absence of Requirements for Improvement (RFIs) indicating observed noncompliance and the Survey Analysis for Evaluating Risk (SAFER) score were used as independent variables in the analysis. Dependent variables included 3 HHCAHPS composite measures and 2 global rating measures. Data were analyzed using 2 sets of random effects logistic regression models. We found that an increase in RFIs scored on an HHA survey was associated with lower HHCAHPS score on all measures. When the frequency of RFIs and SAFER scores increased, there was a corresponding decline in HHCAHPS ratings, suggesting that patient experience ratings can potentially identify quality of care issues, when experience questions and quality concepts are sufficiently aligned. Adherence to Joint Commission accreditation standards may positively influence some aspects of the patient experience of care. While causality remains uncertain, accreditation appears to play a role in contributing to these outcomes.

Consistency of Home Health Performance Associated With Joint Commission Accreditation Status

The CMS Home Health Quality Reporting Program (HH QRP) requires home health agencies (HHAs) to report quality data to measure their performance. This study aimed to assess the relationship between voluntary accreditation with The Joint Commission (TJC) and the ability of HHAs to sustain higher performance over multiple years compared to non-TJC-accredited HHAs. This was a multi-year observational study that analyzed CMS HHA performance data for each year, 2013 to 2019. Measures of interest were the star ratings and 8 quality measures in the HHC dataset with enough variability where a difference between the top and bottom quartile would be meaningful. Close to half of HHAs did not attain the top quartile for any of the study years, but TJC-accredited HHAs generally have a lower proportion of HHAs with 0 year and a higher proportion with 4 to 7 years with top-quartile performance for all measures except the 2 immunization measures. Given a HHA was in the top quartile on a measure the previous year, TJC-accredited HHAs were significantly more likely to remain in the top quartile the year following compared to non-TJC-accredited HHAs. These findings demonstrate better sustained performance among TJC-accredited HHAs compared to non-TJC-accredited agencies. These findings suggest that accreditation requirements may address some of the factors that can threaten the sustainability of positive performance in HHAs. Further research is needed to explore these factors more closely.

Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective.

Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

US State Hospital Regulations Rarely Include Malnutrition but Could Provide a Future Policy Framework for Improving Malnutrition Quality of Care

Malnutrition is a problem that is often not identified in hospitals as 8% of hospital patients are diagnosed but malnutrition is estimated to affect 20-50% of patients. Federal programs such as Joint Commission accreditation and the new, optional, global malnutrition composite score from CMS may improve inpatient malnutrition diagnosis, but there may be an opportunity to do more from a regulatory side. It’s unknown how many states are considering malnutrition from this standpoint. The study’s goal was to collect baseline information on mentions of malnutrition-related terms in state hospital regulations. State hospital regulations were identified in July 2022 using this website &lt;a href="https://www.hortyspringer.com/list-links-state-hospital-regulations/"&gt;https://www.hortyspringer.com/list-links-state-hospital-regulations/&lt;/a&gt; with each regulation double checked each to ensure the most updated guidelines. Hospital regulations from each state plus Washington D. C. (&lt;em&gt;n &lt;/em&gt;= 51) were searched for number of mentions of nutrition and malnutrition and whether terms were included in a nutrition care section. Nutrition was mentioned in 82% of plans, but only 49% included nutrition in a nutrition care process section. Malnutrition was mentioned infrequently, with only three states (6%) mentioning malnutrition and only two states (4%) mentioning malnutrition in a nutrition care section. There was only one significant difference in frequency of term mentions by US region (average in Midwest 4.69, in Southeast 24). Incorporating malnutrition and nutrition care processes into state hospital regulations and defining enforcement of regulations may help increase inpatient identification of malnutrition.

The Have and Have Nots: Characteristics of Hospitals With a Pediatric Palliative Care Program.

Pediatric palliative care (PPC) is a board-certified subspecialty1 that provides expert medical management to patients with serious illness. PPC improves pain and nonpain symptoms,2,3 optimizes communication and goal concordant care,4,5 and improves patients’ quality of life.6 Still, PPC programs are neither ubiquitous nor uniformly staffed throughout the United States.In this issue of Pediatrics, Weaver et al7 highlights characteristics of hospitals with a pediatric palliative care program. Past studies have investigated PPC program prevalence, team composition, and services offered; however, these studies have relied on self-reporting.8,9 This study is novel because it used The Children’s Hospital Association Annual Benchmark Report to examine PPC program prevalence and the characteristics of hospitals supporting these programs. As such, we now understand that an unacceptable 20% of pediatric hospitals lack a PPC program.This finding could be perceived as the study’s primary takeaway. Yet, its real impact is its elucidation of differences between hospitals that do and do not support a PPC program. Weaver et al grouped characteristics into operational, missional, educational, and financial categories to give the results structure. They found that larger hospitals with higher acuity are more likely to have PPC programs. Hospitals with pediatric-friendly home hospices and/or respite care in their community are more likely to have a PPC program. Results also highlight that hospitals with Joint Commission accreditation or Magnet Nursing Designation, Accreditation Council for Graduate Medical Education training programs, or an Accountable Care Organization are statistically more likely to have a PPC program.This constellation of hospital characteristics suggests that they and their communities have the financial health to optimize all aspects of pediatric health care. Hospital size, visit volumes, patient acuity, and possessing an Accountable Care Organization are all drivers of financial health. Additionally, these hospitals can and do support the costly endeavor of staffing, training, and maintaining Magnet Nursing Designation, Joint Commission accreditation, and Accreditation Council for Graduate Medical Education training programs. They also support a PPC program, which typically cannot cover its operational costs, let alone generate revenue because of how reimbursement structures currently exist. PPC program existence and growth require operational and philanthropic financial support.Hospital financial health may also be a substantial factor why 20% of pediatric hospitals do not have a PPC program. PPC has now been a valuable subspecialty for decades. It is not novel nor is it limited only to end-of-life care and thus of limited utility. These traditional reasons for the lack of a PPC program are no longer relevant. Rather, this study provides data supporting the belief that finances now determine the presence and likely growth of a PPC program within a hospital.This study’s true “pearl” is the unveiling of this disparity. Moreover, without national metrics or other incentives, hospitals lack the motivation and likely will not have or grow PPC programs unless new motivations or mandates emerge. This study is a call to action for all pediatricians to join PPC providers who have long advocated for change. We need state and national PPC payment models to ensure all hospitals can afford programming. We also need national requirements on the presence and staffing requirements of PPC within hospitals to give health systems a reason to accept the costs of supporting a PPC program. Only then will the thousands of children in need of PPC have access to it.10

An Interview with Mark Chassin.

Mark Chassin, MD, FACP, MPP, MPH, former president and CEO of The Joint Commission, is one of this year's recipients of the John M. Eisenberg Patient Safety and Quality Awards. During his 14 years as president, Dr. Chassin oversaw the activities of the nation's predominant standards-setting and accrediting body in health care. He introduced profound changes to Joint Commission accreditation and certification programs during that time. Under his leadership, accreditation shifted away from simply citing deficiencies to helping to drive improvement, as summarized in the motto, "Evaluate, educate and inspire." He has had a remarkable career and is being recognized with an Honorary Lifetime Achievement Award by The National Quality Forum and The Joint Commission, the sponsors of the Eisenberg Awards.

A Multistate Comparison Study of COVID-19 Cases Among Accredited and Nonaccredited Nursing Homes.

Widely acknowledged is the disproportionate number of COVID-19 cases among nursing home residents. This observational study examined the relationship between accreditation status and COVID-19 case rates in states where the numbers and proportions of Joint Commission accredited facilities made such comparisons possible (Illinois (IL), Florida (FL), and Massachusetts (MA)). COVID-19 data were accessed from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Public Use File, which included retrospective COVID-19 data submitted by nursing homes to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network. The outcome variable was the total number of nursing home-identified COVID-19 cases from June 2020 to January 2021. Joint Commission accreditation status was the independent variable. Mediating factors included state, and county-level case rates. Increases in the county rate had a significant association with higher nursing home COVID-19 case rates (p < .001). After adjusting for county case rates, no differences were observed in the mean group case rates for accredited and nonaccredited nursing homes. However, comparing predicted case rates to actual case rates revealed that accredited nursing homes were more closely aligned with their predicted rates. Performance of the nonaccredited nursing homes was more variable and had proportionally more outliers compared to accredited nursing homes. Community prevalence of COVID-19 is the strongest predictor of nursing home cases. While accreditation status did not have an impact on overall mean group performance, nonaccredited nursing homes had greater variation in performance and a higher proportion of negative outliers. Accreditation was associated with more consistent performance during the COVID-19 pandemic, despite being located in counties with a higher prevalence of COVID-19.

Elements of the care environment influence coronary artery bypass surgery readmission

BackgroundCoronary artery bypass grafting 30-day unplanned readmission is a focus for the CMS Hospital Readmissions Reduction Program. Awareness of the critical elements of the care delivery environment, including hospital infrastructure and patient clinical profiles that predispose toward readmission, is essential to proactively decrease readmissions. MethodsThe Healthcare Cost and Utilization Project-State Inpatient Database, American Hospital Association Annual Health Survey Database, and Healthcare Information Management Systems Society data sets were merged to create a single data set of patient- and hospital-level data from 8 states. Isolated coronary artery bypass grafting procedures were queried for all-cause 30-day readmission, and backwards stepwise logistic regression was performed. Readmission rate was then used to categorize hospitals into quartiles, and analysis focused on the hospitals with the lowest (Q1) and highest (Q4) readmission rates. Univariate analysis was performed comparing Q1 and Q4 hospitals. ResultsA total of 150,215 patients underwent isolated coronary artery bypass grafting with 23,244 (15.5%) readmitted patients among 903 hospitals. Model area under the curve was 0.709 (95% confidence interval, 0.702–0.716), with the top 3 readmission determinants related to discharge disposition. Compared to Q1, Q4 patients more often were female, were >70 years of age, and had Medicare as a primary payor (P < .001). Low readmission rate hospitals were characterized by higher costs; not-for-profit status; having Joint Commission accreditation; and higher total admissions, operative volume, hospital/ICU beds, full-time physicians, nurses, and ancillary personnel (P < .001). ConclusionReadmission after coronary artery bypass grafting is strongly influenced by discharge disposition. However, hospital factors such as scale, personnel, and ownership structure are significant contributors to readmission. Focus beyond patient factors to include the entire continuum of care is required to enhance outcomes, of which readmission is one surrogate measure.

The Relationship between Accreditation and Performance among Federally Qualified Health Centers

While past studies have examined the relationship between accreditation and hospital performance, no previous studies have evaluated the relationship between Joint Commission accreditation and Federal Qualified Health Center (FQHC) performance. Data from secondary sources for 1,355 FQHCs in 2016 were analyzed to evaluate the association between Joint Commission accreditation and organizational and environmental market factors and clinical and non-clinical performance outcome measures. The study’s findings reflect the positive relationship between Joint Commission accreditation and certain organizational factors (patients at 200% of federal poverty level, uninsured patients, patients with Medicaid and/or CHIP coverage, and FQHC size) and environmental market factor (target population), and a number of performance measures (adolescent weight screening, adult weight screening, cholesterol treatment, and total grant expenditure). While past studies have examined the relationship between accreditation and hospital and other health organizations performance, no previous studies have evaluated the relationship between The Joint Commission accreditation and Federal Qualified Health Center (FQHC) performance. This study filled a gap in the literature because research remains limited among FQHCs.

Quality, Safety, and Standards Organizations COVID-19 Impact Assessment: Lessons Learned and Compelling Needs.

The stark reality of the COVID-19 pandemic challenged the very systems established to ensure the nation’s safety and quality. The pandemic resurfaced long-endemic challenges within the health care quality and standards ecosystem and identified novel challenges that cannot be ignored. This paper examines: 1. the health care quality and standards ecosystem pre-pandemic; 2. vulnerabilities in quality and standards organizations exposed by COVID-19; 3. quality and standards organizations’ responses during the pandemic; 4. opportunities to improve the national response to improving quality and safety overall with a particular focus on readiness in the case of disasters, pandemics, or other national emergencies; 5. sector-wide policy, regulatory, and legal changes that might be transformative; and 6. priorities moving forward. The quality and safety focus of the American health care system has a long history, dating back to the 19th and early 20th centuries. Quality of care is generally understood as providing the right care for the right person at the right time—every time. Several seminal laws and publications over the last 60 years have shaped the current quality landscape in profound ways and have been cataloged in numerous publications [1,2,3,4]. These publications generally point to several landmark occurrences that have shaped the evolution of quality measurement, improvement activities, and safety standards over the years. The evolution has centered around four main levers (see Figure 1): Open in a separate window FIGURE 1 Key Levers for Care Quality and Safety 1. survey, certification, and accreditation of facilities, laboratories, health plans, and providers; 2. quality measurement, incentives, and payment reforms; 3. public ratings of providers and facilities; and 4. quality improvement learning and action networks. Survey, Certification, and Accreditation The role of government in establishing quality and safety standards for the health care system became prominent with the implementation of the 1965 Medicare legislation, in which Congress explicitly tied payment to the achievement of minimum health and safety standards, commonly known as conditions of participation (CoPs). Initially, the CoPs focused on medical staff qualifications, nursing services, and utilization review, but have since evolved to include minimum standards for various other important safety issues, including infection control, emergency preparedness, quality assurance, performance improvement, and medication management. States also established health and safety requirements for facility licensure. State standards for health and safety must, at a minimum, align with the CoPs but may go above and beyond the federal requirements. While the state government and federal surveyors perform inspections for many facilities (primarily nursing homes), the Centers for Medicare and Medicaid Services (CMS) has approved several national accreditation organizations (AOs) to perform survey functions [5]. One of the largest AOs is the Joint Commission. Founded in 1951, the “Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor’s [sic] offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services” [65]. In 1990, the National Committee for Quality Assurance (NCQA) was established as a nonprofit organization that accredits quality programs for health plans, physicians, and other providers. NCQA developed the first set of standards for health plan quality using a set of evidence-based requirements and measurements.

Electronic health record adoption among US substance use disorder and other mental health treatment facilities

ObjectiveThis study examined Electronic Health Record (EHR) utilization among US substance use disorder (SUD) versus mental health (MH) treatment facilities. MethodsData from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey were used to examine differences in clinical and administrative utilization of EHR. ResultsEHR use was significantly less common among SUD facilities compared to MH facilities for both non-exclusive (mixed computer and paper) and exclusive (paper-free) use. Fewer than 25 % of facilities of either type reported exclusive EHR use for core clinical activities (progress notes, laboratory monitoring, and prescriptions) with wide variability among states. Being an inpatient facility, having Joint Commission accreditation, being a private-for-profit, or a public facility were significantly positively associated with exclusive EHR use for core clinical activities; these associations were stronger among SUD facilities than MH facilities. Accepting Medicare was associated with exclusive EHR use for core clinical activities in both facility types, while accepting private insurance was associated with such use only among SUD treatment facilities. ConclusionsEHR adoption among SUD facilities lags behind MH facilities. However, exclusive EHR use for clinical purposes remains elusive for both types of facilities with no more than a quarter of facilities in any state reporting such use. Some of the factors associated with exclusive EHR use for clinical purposes among SUD treatment facilities—such as Joint Commission accreditation—may be policy leverage points to expedite EHR adoption in these facilities.

Ongoing Professional Practice Evaluation for Emergency Medicine Physicians in a Large Health Care System

Ongoing professional practice evaluation (OPPE) is designed to identify professional practice trends that affect quality and safety of practicing physicians. Focused professional practice evaluation (FPPE) is employed when physician nonconformance is identified. The goal of this novel OPPE initiative was threefold: (1) meet The Joint Commission's accreditation standards, (2) assess documentation for compliance and risk, and (3) maintain procedural competency to provide optimal patient care. A quality assurance project with OPPE program development was initiated in 18 emergency departments across a large health care system. First, a monthly comprehensive peer review meeting assessed cases across the system for medicolegal risk. Physicians with reasonable practice concerns were identified and referred to FPPE. Second, a standardized OPPE chart review was performed biannually by a quality assurance committee assessing all physician charts for clinical care, medicolegal risk, and quality. Last, completion of a procedure lab every three years was required to maintain competency. For systemwide peer review in 2019, 47 cases were referred and 12.8% had quality concerns. For standardized OPPE chart review, 221 physicians were reviewed on 1,219 charts on the following metrics: insufficient medical decision making, diagnoses not medical/legally supported, and charts with red flags. Nine physicians (4.1%) and 17 charts (1.4%) were deficient in all three measures, and 8 physicians (3.6%) had deficiencies in ≥ 50% of their charts. For procedure lab competency, 19.0% of physicians completed the lab in 2019 with no quality concerns. A structured OPPE algorithm can aid large health care systems in identifying deviations from practice standards for which additional FPPE can be beneficial.

Antibiotic stewardship teams and Clostridioides difficile practices in United States hospitals: A national survey in The Joint Commission antibiotic stewardship standard era.

Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship. Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression. Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies. Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non-ID-trained pharmacists and clinicians in antibiotic stewardship.

A Guided Survey Approach for Joint Commission Preparedness in Radiology

Radiology practices across the United States aspire to Joint Commission accreditation, the nation’s gold standard certification of effective, efficient, and safe patient care. Toward that end, radiology department leaders devote substantial effort searching the available literature to better understand the expectations of TJC and thus better prepare their organization for the review process. In this article, we review and summarize current recommendations and standards of practice in order to facilitate the self-assessment process. We present an efficient, interactive survey tool that can aid practice leaders, including radiologists and administrators, as they internally survey their own departments in preparation for The Joint Commission survey process.

Soiled Instrument Handling in Outpatient Clinics; Our process to compliance

BACKGROUND: The outpatient clinic system of about 35 centers, including 4 ambulatory surgery centers (ASCs) with central sterilization (CS) services, was incorrectly handling and transporting soiled instruments. Non-ASC instruments were hand-carried through hallways to collection bins on countertops in clerical areas. Bins did not meet standards. Bins from outreach centers were left in mailrooms for courier collection, and were mixed with clean items. Some bins still contained a portion of the water/enzymatic soak solution. METHODS: A task force was formed to improve the process at the clinic site with the largest ASC first. The other clinic sites with ASCs and then the remaining outreach centers followed suite. New instrument bins were purchased and a new instrument spray replaced soaking. Soiled utility rooms were constructed where there were none. A policy, procedure, checklist, algorithm and training video were made and placed in an online toolkit. Couriers were given turn-by-turn directions to all the soiled utility rooms and were educated on maintaining separation of clean and dirty within the transport vans. RESULTS: With support starting at the executive level, safe soiled instrument handling and transportation resulted system-wide after seven months. Joint Commission accreditation was achieved. I, along with my coworkers, continue to educate staff as necessary to make this process their “new normal” for soiled instrument handling. CONCLUSIONS: Process change across a large healthcare system requires commitment at the executive level including funding and educational tools.

Perceived Value of the Daily Safety Briefing

A hospital-level daily safety briefing (DSB) is a time for leaders to come together and address recent and upcoming safety challenges in the hospital. As tools to facilitate communication and teamwork, DSBs are important, but their value has not been extensively studied. We studied the value of the DSB by means of a prospective written survey of participants of the DSB at an urban academic medical center. Participants were unit managers, directors, vice presidents, and various other hospital leaders.Ninety-seven of 114 participants completed the survey (85%). Of all the activities rated, preprocedural time-outs had the highest rating in terms of impact on patient safety (4.87 ± 0.50 on 5-point Likert scale). The DSB had a rating (4.44 ± 0.77) that was on par with The Joint Commission accreditation activities (4.47 ± 0.68) and higher than use of the Morse Fall Scale (4.10 ± 0.83). Overall, 95% of the participants felt that a DSB was an effective use of participants' time. The top two benefits of the DSB were keeping patient safety a focal point in the organization (4.54 ± 0.74) and increasing awareness about patient safety issues (4.52 ± 0.93).We conclude that the DSB improves communication among team members and is a valuable use of healthcare leaders' time.

Organizational characteristics associated with the provision of cultural competency training in home and hospice care agencies.

Despite the increasing interest in community-based health care, little information exists on cultural competency training (CCT) and its predictors in this setting. We examined the associations between six organizational characteristics and the provision of CCT in home health care and hospice agencies. We used cross-sectional data from the agency component of the 2007 National Home and Hospice Care Survey. The CCT provision composite was composed of three items: whether the agency provides mandatory cultural training to understand cultural differences/beliefs that may affect delivery of services to (a) all administrators, clerical, and management staff; (b) all direct service providers; and (c) all volunteers. Organizational characteristics were volume, ownership status, chain membership, teaching status, Joint Commission accreditation status, and formal contracts. The weighted sample (n = 14,469) had a mean CCT provision score of 1.75 (range = 0-3). Our ordinal logistic regression model showed that Joint Commission accreditation increased CCT provision odds in the home health (odds ratio [OR] = 2.07, 95% confidence interval [CI] [1.01, 4.24]) and hospice (OR = 4.40, 95% CI [2.07, 9.38]) settings. Teaching status increased CCT provision odds (OR = 2.71, 95% CI [1.19, 6.17]) in the home health setting. Formal contracts increased CCT provision odds (OR = 4.03, 95% CI [1.80, 9.00]), whereas not-for-profit ownership decreased CCT provision odds (OR = 0.19; 95% CI [0.07, 0.50]) in the hospice setting. Home health care and hospice agencies need to increase their CCT practices to overcome health disparities in an increasingly diverse and aging population.