Thursday, December 29, 2011

The Joint Commission Dementors

Fans of the Harry Potter books and movies are familiar with the characters called dementors. These are creatures who guard the wizard prison Azkaban. Their presence causes one to feel cold and lifeless, losing all sense of hope and happiness. Prolonged exposure to their presence eventually drives one into madness. That is what being inspected by The Joint Commission feels like.

Our hospital recently had its inspection by this nongovernmental agency formerly known as JCAHO. I commented before on the lunacy of some of the rules that TJC imposes on healthcare providers that don't seem to affect the quality of patient care. Many of us feel that in order to justify their existence, TJC kind of makes up stuff along the way in order to sound authoritative and put doctors and hospitals in their place.

For instance, while inspecting one of the operating rooms, one of the members of TJC told us that the trash basket has to be at least five feet away from the dirty laundry basket. Now what is the logic of that? Are there any studies to prove that a dirty laundry basket sitting next to the trash worsens a patient's health? So we dutifully pulled the baskets apart in each O.R. Another inspector decided that clipboards made from wood or particle board were verboten in the O.R. Why? Don't ask me, ask TJC. When word got out on that, the O.R. managers went rushing madly through all the rooms to make sure all the wooden anesthesiologists' clipboards were thrown out and replaced with plastic and metal clipboards. I was amazed how all those brand new plastic clipboards materialized so quickly. Is that insane? I could go on and on about these stories of random acts of lunacy. I can't forget to mention that our bulletin board had to be removed thanks to TJC. Apparently some of the clippings of personal notes and pictures that were stuck on the board were not secured properly. They were pinned to the bulletin board with thumb tacks causing the corners of the notes to kind of droop down due to that force called gravity. I guess TJC doesn't like gravity. They felt that those droopy paper corners could be a potential fire hazard and said all the notes had to come down. However if all four corners of the notes were stuck securely to the board, they were okay. WTF?

Some of the anesthesia related irritations by TJC include the perennial question about locking anesthesia carts. Our particular group of inspectors hadn't gotten word yet that TJC and the ASA had agreed on when it is appropriate for anesthesiologists to leave their carts unlocked. They wanted our carts locked whenever the anesthesiologist leaves the room, even though the O.R.s are considered secured areas of the hospital. They also suggested that we label our syringes when performing regional blocks. Sounds reasonable, you ask? Well how is one supposed to put nonsterile labels on sterile syringes while wearing sterile gloves during the performance of a block? Plus the syringes and medications never leave the sight of the practitioner so why is labeling required?

Our hospital spent months preparing for these "surprise" inspections by TJC. We rehearsed our time outs studiously. Our syringes were randomly inspected to make sure they were all labeled with the drug name, date, time, and initials of the person who drew the drug. Personal effects were banned from the O.R.'s or had to be placed in plastic bags. But you can't prepare for this kind of irrationality. It's a travesty that healthcare providers have to subjugate ourselves to these insulting inspections. They know we do a good job taking care of patients so they come up with these excuses to demoralize us. They are aware that if our facility doesn't get their approval, Medicare and insurance companies will no longer do business with us. How this organization acquired their monopoly on inspecting hospitals and the government's continued reliance on their seal of approval is beyond me. It seems that TJC has a conflict of interest in their business. They don't have a book of all the rules that a hospital has to follow in order to receive approval. If they did every hospital would follow it to the letter and there would no longer be a need for TJC. Instead they make up these random on the spot rules to justify coming to our facility and insult our patient care.

Don't laugh at our frustrations. TJC will soon be coming to your hospital soon. In fact, they are expanding internationally to inspect overseas hospitals thanks to all the medical tourists out there. Let's see if those doctors and nurses in Thailand, India, or Dubai give a darn about droopy corners on their bulletin boards.

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