Mortality improves during surprise Joint Commission inspections

When Joint Commission inspectors are conducting hospital surveys, 30-day mortality rates “significantly” improve, according to a new study published in JAMA Internal Medicine.

The study was authored by Michael Barnett, MD, Harvard University professor and primary care physician at Brigham and Women’s Hospital, along with Harvard Medical health policy professor Anupam Jena, MD, PhD and research assistant Andrew Olenski.

Using data from almost 2,000 hospital surveys between 2008 and 2012, the authors examined patient outcomes in the period from three weeks before the inspection to three weeks after. The objective was to determine whether the “heightened vigilance” from having inspectors watching affected patient outcomes such as 30-day mortality, Clostridium difficile infections and in-hospital cardiac arrest mortality.

According to their results, the inspections definitely had an impact on mortality rates. Overall, there was a relative decrease in 30-day mortality of 1.5 percent “potentially attributable to [the Joint Commission] surveys,” with a greater relative decrease of 5.9 percent seen in major teaching hospitals.

Among the other patient safety indicators, however, there was no significant change between survey and nonsurvey periods.

The improvements on mortality couldn’t be pinned on other factors, as the “mean weekly number of admissions, patient characteristics, reasons for diagnosis and in-hospital procedures performed were nearly identical between survey and nonsurvey weeks,” according to the study.

“The most plausible mechanism for these results could be that heightened scrutiny during visits raises awareness of possible operational deficiencies that could improve patient safety,” Barnett and his coauthors wrote. “For example, increased attention to methods of paper documentation could lead to more carefully documented encounters and better communication during survey weeks than other weeks.”

The results were also reversible, as mortality rates were stable at the times prior to and following the inspections.

Whatever changes are being made, if those results could be achieved throughout the year, they could have a tremendous impact on public health. The authors recommend hospitals use their next unannounced survey to figure out what’s driving those improvements.

“One strategy for health systems to consider would be to observe which aspects of normal day-to-day operations change most dramatically in their institution to meet survey readiness standards (e.g., clean environment and proper documentation). Those changes may be the best opportunities to identify whether more continual attention could improve patient safety,” the authors concluded.