According to a recent US study, unannounced on-site inspections of hospitals by the U.S. Joint Commission, an independent non-profit group, have found significant results where fewer patients died during the inspection week.

The results are found to be related to clinicians following the patient safety guidelines more closely to avoid potentially embarrassing violations. The disparity of practices was more pronounced at major teaching hospitals, as the researchers at Harvard University found.

3,600 deaths per year could be saved

To ensure hospitals abide by the practice guidelines, the Joint Commission which gives accreditation to 21,000 healthcare facilities would carry out surprise inspections every 18 to 36 months. Failure to pass an inspection could result in loss of accreditation, reputation as well as the payments from Medicare and Medicaid.

While the study was conducted to find out whether the response of hospitals could impact mortality rate during inspection weeks, the results showed a modest decline at about 1.5% in the 30-day mortality rate. Based on the mortality data analysed, patients who receive care during the inspection weeks had a higher chance of survival.

At major teaching hospitals, however, the mortality rate dropped to 5.93% during inspection weeks, compared to 6.41% on other days. If the changes made during inspections were sustained, more patient lives could be saved.

“Nearly 3600 deaths could be avoided each year, or 10 deaths per day, if care patterns that are observed during hospital inspection weeks were the same year-round,” Dr Anupam Jena, lead author of the study and health policy researcher at Harvard University said.

“Our findings are surprising because they highlight how increased focus, attention, and cognitive bandwidth, all of which happen when people are being monitored, could lead to measurable improvements in patient outcomes,” Jena added.

Hospital staff more vigilant with inspectors around

The lower mortality rate was attributed to a more generalised vigilance when inspectors are in town rather than specific practices or standards.

“When you’re being monitored you behave differently and you do your job differently,” said Jena.

The researchers suggested that the more noticeable change in large teaching hospitals may be due to their size that made it available for them to mobilise their staff resources. They also have reputations at stake, the authors said, which may be another potential factor.

The study’s led author, Dr Michael Barnett, an assistant professor of health care policy management at Harvard University, on the other hand, condemned the hospitals for putting a show for visiting inspectors who did not view the actual normal operations.

“The results suggest there are opportunities for quality improvement right under our noses that we take for granted,” he said. “You’re not really measuring the quality of the hospital. You’re measuring the capacity of the hospital to mobilise the troops.”

Potential for improving patient outcomes

Sustaining the changes made during inspections on the hospitals’ day-to-day operations is one of the major efforts that could be made to improve patient safety.

While the researchers suggested more in-depth studies are required to examine the relationship between on-site inspections and lower mortality rate, heightened scrutiny during inspections could raise awareness of existing operational deficiencies.

Jena added that hospitals could adjust their schedules and practices to help increase focus and attention to details while a disruption-free policy could be structured for key clinical decisions except for emergency cases.

“This study highlights that there is potential for us to learn what is going on during those weeks that is associated with better patient outcomes,” commented Dr Vineet Arora, a researcher at University of Chicago Medicine who was not involved in the study.

“The question is whether it is due to a concerted effort on the part of the hospitals to follow safe practices or whether there is something else going on.” MIMS

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