“All of these costs are passed along to the patients in increased facility fees,” said Dr. Bock. “These … contribute to the ongoing epidemic increases in national healthcare costs.”
Explore this issue:
December 2018Contaminated instruments have consequences, however. In addition to increased infection rates, having to delay or cancel a procedure due to unsterile instruments leads to delayed treatment and inconvenience to patients and their families, who have rearranged their lives, as well as possibly increased waiting times. “Physicians and surgeons are often unaware of the mission and vision of TJC, which is [to ensure that] ‘all people always experience the safest, highest quality, best-value healthcare across all settings,’” said Julie L. Wei, MD, surgeon-in-chief at Nemours Children’s Hospital in Orlando. “Reviewers for TJC will point out deficiencies that must be corrected to deliver the mission of improving health care and inspiring us to excel to provide safe and effective care of the highest quality and value.
“As a surgeon, I may not agree with or feel inconvenienced by rules and regulations; as a parent, if my own daughter needed surgery, we would only take her to a hospital and healthcare organization whose culture and practice is aligned with TJC’s zero-error aspirational goal,” she said. “Until the day medical errors are no longer the third leading cause of death in the U.S., we simply can’t be vigilant enough.”
As a surgeon, I may not agree with or feel inconvenienced by rules and regulations; as a parent, if my own daughter needed surgery, we would only take her to a hospital and healthcare organization whose culture and practice is aligned with TJC’s zero-error aspirational goal. —Julie L. Wei, MD
Surgical Attire
Another area where there is disagreement with standards is in head-covering regulations issued by the Association of periOperative Registered Nurses (AORN) and adopted by some. They require a bouffant head covering, which impacts a physician’s ability to wear a cloth covering. This is viewed by many as an unwarranted intrusion on a physician’s autonomy, and, ultimately, a contribution to physician burnout.
These concerns led the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) to survey its membership and develop a list of concerns, which they then presented to TJC. While TJC was willing to listen and discuss the concerns, many of the top concerns, such as peel packing, decontamination procedures, and surgical attire, were results of unintended over-interpretations of the guidelines. While there were areas where the Commission said they do not have specific requirements, their surveyors were still handing out citations for “violations” as if these requirements existed.