Due to TJC’s influence, one hospital or clinic being cited for something usually is communicated throughout the industry, and a domino effect occurs. These are then enshrined in hospital policies and procedures and implemented at the local level. “Once one hospital is dinged by TJC surveyors for something, other hospitals are going to revamp their processes in response,” said Dr. Chang. “This propagation of misinterpretation takes off and grows wild.”
Explore this issue:December 2018
Continued discussions, both within the specialty and with TJC going forward, are important. One of the outcomes of the Academy/TJC talks was the publication of an article in The Joint Commission’s bulletin that included clarifications for surveyors related to the issues discussed (Jt Comm J Qual Patient Saf. 2018;44). TJC also agreed to publish an online FAQ to further communicate these policies and procedures to those in the field.
“We as surgeons like to say that TJC and others don’t have a lot of good evidence for their side,” said Dr. Chang. “The problem is, we don’t often have much high quality evidence supporting our stance either. In the end, both have to recognize that we aren’t going to eliminate every little bug without enduring very large costs. While an ounce of prevention may be worth a pound of cure, is a pound of prevention worth an ounce of cure?”
There are also discussions to be undertaken at individual facilities. Some concerns may be rooted in how hospital administrations interpret TJC requirements. “The perspective and attitude should be to not fight them,” said Dr. Wei. “You need to know who in your system and professional organization you can share feedback with and how your hospital shares that with TJC.”
She also says it is a matter of being prepared. If you are a frontline surgeon, ask your chief and your chair about any concerns. Their awareness and knowledge are key. Understand the requirements and your specific institution’s response to them. Often for TJC, the greater sin is not following the facility’s policies and procedures.
The bottom line is that no physician would argue against an evidence-based requirement, as patient safety remains paramount. “We need to proceed with these decisions using a basis of data as much as possible,” said Dr. Bock. “It often seems they are making these clinic instrument sterilization decisions based on what they think makes sense, but not always based on data.”
Kurt Ullman is a freelance medical writer based in Indiana.