Patients in U.S. hospitals during surprise accreditation inspections may have a slightly lower risk of dying within 30 days of their admission compared with those treated weeks before or after such unannounced surveys.
These are the findings of a new study, which observed that this effect does not seem linked to inspection factors, such as hospital-acquired infections and other aspects of patients’ safety, but instead to the overall increased awareness of clinicians due to observation.
Death Rates And Surprise Inspector Visits
Examining mortality data from almost 2,000 hospitals from 2008 to 2012, the team found that during surprise inspections, 7.03 percent of patients died within a month of hospital admission, while at other times the rate was 7.21 percent.
The difference was greater at major teaching hospitals, where death rates dipped to 5.93 percent during inspection weeks versus 6.41 percent at other periods. The steeper drop in mortality risk may root from the greater resources and clinical staff of these centers, the researchers observed.
Across U.S. hospitals, there was a 1.5 percent drop in mortality during inspections weeks and a more pronounced 5.9 percent reduction during inspection periods in major teaching hospitals.
“Our results suggest that heightened focus and attention during periods of intense observation may influence clinical decision making and downstream patient outcomes,” said senior study author and Harvard health policy researcher Dr. Anupam Jena in a statement.
These results are surprising since they highlight the greater focus and attention that happen when someone is being monitored, Jena added in a Reuters report.
The research focused on inspections conducted by the nonprofit The Joint Commission, or TJC, which evaluates hospitals at least once every three years to monitor how patient safety procedures are being done to avoid preventable deaths, infections, and medical errors.
“The stakes for performance during a TJC survey are high: loss of accreditation or a citation in the review process can adversely affect a hospital’s reputation and presage public censure or closure,” the authors wrote in the study published in the journal JAMA Internal Medicine.
The team examined data on patients under Medicare, the country’s health program for the elderly, and included 244,787 patients confined during inspection weeks as well as 1.46 million patients hospitalized three weeks before and after inspection times.
What The Results Suggest
The absolute drop in 30-day mortality rates of 0.39 percent during surprise inspections at major teaching hospitals, according to Jena, may lend insight on how to improve service throughout the year.
Almost 3,600 deaths a year or 10 deaths a day could be prevented if care patterns during inspection periods were adopted all year round, Jena said.
The study did not identify what might have led to the findings, but there are different potential reasons, such as paying closer attention to things such as hand washing when inspectors are around. Jena noted, however, that there weren’t fewer infections or negative safety occurrences during these weeks than at other periods.
Dr. Vineet Arora from University of Chicago Medicine said that inspection-week patients may be different from those seen at other times of the year, or hospitals are simply more vigilant and therefore providing better care when inspectors arrive.
Earlier this month, new work limits will allow young doctors to work longer shifts, lifting the 16-hour limit put in place back in 2011 over doctor and patient safety concerns. Taking effect on July 1, the rule will allow doctors in training on their first year to work up to 28 hours or more.
Just last week, the reported move of Mayo Clinic to stamp its preference on patients maintaining commercial insurance triggered a strong reaction from senior health officials.
A leaked video transcript of Mayo CEO Dr. John Noseworthy's counsel to the employees on the new policy was obtained by the media, triggering opposition in healthcare circles. Mayo has confirmed the video’s authenticity.
