BB&T Contributing Writer
BB&T Executive Editor

CHICAGO — Probably not coincidentally, the 21st annual conference on Healthcare Quality and Patient Safety was held here — amid an audience of 400 hospital compliance officers, directors of quality, risk managers, and a wide variety of regulators and accreditation officers — the very day that The Joint Commission (Oakbrook Terrace, Illinois) released its annual hospital report for the year 2007.

"Not surprisingly, over 90% of all hospitals surveyed met 10 of the 16 compliance measures," said Dennis O'Leary, MD, president of The Joint Commission. "What was surprising was the variability among hospitals on the six issues where hospitals still need to improve."

He went on to say that the remaining six criteria set by the commission "did not achieve the 90% hospital compliance level." He said that the failure to reach the 90% level "occurred in less than 50% of the hospitals, but these are the issues that need to be addressed."

The Joint Commission's data indicates steady gains being made. The figures indicate that in 2006 only four of the measures tracked achieved 90% compliance.

The Annual Report on Healthcare Quality & Patient Safety is now in its second year of publishing to the public. For 22 years the commission has been surveying hospitals and reporting back to them in order that they may improve their quality and safety. In addition, the annual conference is held to assist hospital executives in decisions to improve healthcare quality, reduce errors, and build leaders throughout their organization.

"Now that we find ourselves in an age of transparency, it is imperative that we allow the public access to the data collected and analyzed on all hospitals on their performance. Modern medicine now employs performance measurements that can be used to manage objectively in order to improve on patient safety," said O'Leary.

The commission provides specific definitions for quality and safety that need to be understood. It defines decreased quality as an error of omission, or something that was not done that should have been; it defines a problem with safety as an error of commission, or something that reached the patient that should not have.

Hospitals continue to be challenged in meeting certain patient safety requirements, and there is significant variability among the hospitals in meeting performance standards.

Biggest errors in communication

Amy Panagopoulos, RN, director of the Division of Standards and Survey Methods for The Joint Commission, reviewed the top challenging standards that need to be improved.

Among these were to improve the accuracy of patient identification, the effectiveness of communication among caregivers, and the safety of using medications. "Patient identification standards will decrease the amount of wrong-site, wrong-patient, wrong-procedures which are a continuing problem that has actually increased since the standards were established.

Panagopoulos said that extensive efforts are being made to refine this protocol, suggesting that the protocol may offer some sorts of barriers to compliance by hospital personnel. She said that refining the communication standards will serve to clarify approved abbreviations that may be used, as well as publish those that are on a "Do Not Use" list.

All medications are required to be labeled, regardless of their containers, their singularities, their obvious uses, and the obvious intended patient for them.

"The most frequently occurring type of medical error is an error in medication, while the most frequently cited category of root causes for serious adverse events is ineffective communication," said Panagopoulos. "Refined standards should help us improve in these areas."

Jerod Loeb, PhD, executive VP of the commission, said, "identifying, implementing, and maintaining evidence-based performance measures are the core tool for accreditation. Performance in healthcare is a measure of what was done and how well it was done; and performance will lead to results. What is measured is what will be managed."

Loeb said that the commission attempts to set standards that are closely tied to outcomes in order to make improvements but he also pointed to the expense and lengthy time required for outcome studies.

Thus, he said that mistakes may be made while waiting for outcomes study results to determine the correct standard and set that standard.

As a case in point, Loeb asked the audience: "How long does it take to get the results of an outcome study on the five-year survival rate for cancer?"

His answer: five years.

And five years is too long to wait to implement a patient safety measure and determine if it is working. His point was that greater speed is needed. "We need to measure processes that are closely tied to outcomes so that we can realize the improvements sooner than it would take to wait for the outcome."

While that presents a Catch 22 of sorts, Loeb said that the way to do this is to establish standards or processes by checking their validity and reliability and then carefully testing them in the field before the measurement is utilized.

He said, "Because the stakes are high [in terms of patients' lives], standards development is a team sport where all aspects of the hospital are involved, and then they are endorsed by the national hospital quality forum as well.

"We have seen that what gets measured gets done, as evidenced by the steady improvement in hospital safety measures since this has been instituted," Loeb said.

The findings …

Among the specific findings in the report:

Accredited hospitals continue to show measurable improvements in performance, with over 50% improvement in some areas. Key areas with continued improvements and high compliance are heart attack care, heart failure care, and pneumonia care — all working to save more lives.

Hospitals continue to be challenged in meeting certain patient safety requirements.

There is significant variability among the hospitals in meeting performance standards. These variabilities are seen in hospital performance, state to state, and between the highest- and lowest-performing hospitals.

Hospital are being required to follow standardized processes for quality measurement, reporting.

Hospitals continue to be challenged in meeting certain patient safety requirements.

Room for improvement exists with most of the quality measures.

The final take-home message, Loeb said, was "that as long as we keep shining the light on what needs to be measured, we see improvement. Once we stop shining the light, the measurement deteriorates. We need to continue to shine the light."

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