Lack of Evidence to Support Accreditation Standards Shows the Need for a New Patient Safety Approach

In a recent blog post, I suggested that we’ve become desensitized to medical mistakes in hospitals that injure or kill patients. My evidence in “Uncomfortably Numb to Patient Harm” was the meager media reaction to a report from HHS’ inspector general’s office that said 25 percent of Medicare beneficiaries suffers an adverse event in the hospital. In other words, medical errors injure or kill one out of every four seniors who goes to the hospital. That stat was pretty shocking to me. It was meh to most others.

I ended that post by arguing that public- and private-sector programs to make patient care safer haven’t worked and that we need to get tougher on hospitals, doctors, nurses and others who routinely provide unsafe care. We should stop paying for poor care and start charging dangerous clinicians with crimes.

A new study in the British Medical Journal suggests I might be on to something. The study, which you can download here, found that less than a third of The Joint Commission’s hospital patient safety accreditation standards were fully supported by evidence that the standard made care safer.

Four researchers affiliated with the Rush Medical College, Northwestern University medical school and the University of Cincinnati medical college looked at 20 “actionable” hospital accreditation standards that took effect between July 1, 2018, and July 1, 2019.

Actionable means that surveyors from the Joint Commission use them to evaluate a hospital and decide whether to accredit the hospital based on those and other standards. When the Joint Commission does accredit a hospital, which happens in most cases, the hospital qualifies to treat Medicare patients. That automatic Medicare certification creates a powerful financial incentive for hospitals to comply with the standards regardless of whether the standards make care safer and more effective for patients.

Each new standard, like the 20 examined for the study, does come with a report that essentially justifies the standard. The report includes references to evidence-based and peer-reviewed research that link the new standard to safer and more effective care for patients.

The researchers conducted a detailed review of the reports that came with the 20 actionable standards that went into effect during the study period. Here’s what the researchers found:

• Eight of the new standards were not supported by their respective reports
• Six of the new standards were only partially supported by their respective reports
• And only six of the new standard were fully supported by their respective reports

In short, the Joint Commission required accredited hospitals to comply with 14 standards that were not fully justified by the evidence-based and peer-reviewed research in their accompanying reports.

Or, as the researchers said, “Recent actionable standards issued by The Joint Commission are seldom supported by high-quality data referenced within the issuing documents.”

Here are examples of two standards that the researchers said weren’t supported by their reports:

• The organization has defined criteria to screen, assess, and reassess pain that are consistent with the patient’s age, condition, and ability to understand.
• Critical access hospital leadership works with its clinical staff to identify and acquire the equipment needed to monitor patients who are a high risk for adverse outcomes from opioid treatment.

Here’s the twofold problem I see with what the researchers uncovered. First, hospitals are doing things that may — or may not — improve patient outcomes simply because they want Medicare to pay them for care to beneficiaries. Second, more resources devoted to things that may — or may not — improve patient outcomes means fewer resources for things that do.

Accreditation is a long-running private-sector patient safety initiative that really hasn’t done much to make care safer for patients, at least as suggested by this study.

It’s definitely time to try something else. Just ask one in four Medicare patients.

Thanks for reading.