Patients admitted to hospitals while the facilities were undergoing an unannounced Joint Commission inspections had lower 30-day mortality rates when compared with patients who were admitted during weeks leading up to or following the surprise visit, according to a study published Monday in JAMA Internal Medicine.
For the study, researchers from Harvard Medical School and the Harvard T.H. Chan School of Public Health reviewed data on Medicare admissions at 1,984 hospitals that were surveyed by the Joint Commission from calendar year 2008 through 2012. The researchers looked at Medicare admissions data for the three weeks leading up to hospitals' Joint Commission visits, as well as during the visits and for the three weeks following the visits, and compared the data.
The researchers found that there was a total of 244,787 admissions during Joint Commission inspections at hospitals included in the study from 2008 through 2012, compared with 1,462,339 admissions that occurred during the three weeks before and three weeks after inspections.
According to the researchers, the average 30-day mortality rate among all hospitals included in the study was 7.21 percent during the three weeks before and three weeks after inspections, compared with 7.03 percent during inspections.
The researchers said the difference in 30-day mortality rates was even more pronounced when looking only at teaching hospitals, which had an average 30-day mortality rate of 6.41 percent during the three weeks before and the three weeks after inspections, compared with 5.93 percent during inspections.
The researchers said it is unclear why average 30-day mortality rates were lower during Joint Commission inspections than they were in the weeks leading up to and following the visits and suggested further research on the topic.
However, Anupam Jena, the study's lead author and an associate professor at Harvard University, suggested that the "focus and attention" physicians "plac[e] on clinical care goes up" when they are being monitored, leading them to more correctly match diagnoses and treatments.
Further, the researchers said hospital staff might pay more attention to potential operational deficiencies when they are under review and more closely follow care and infection control protocols.
The researchers also said teaching hospitals might have experienced greater changes in their mortality rates when compared with other hospitals in the study because the teaching hospitals' larger sizes allow them to more effectively mobilize their staff. The researchers added that teaching hospitals also might have responded more robustly to the inspections to protect their reputations.
The researchers suggested that hospitals pay closer attention to changes in the facilities' day-to-day operations when they are under review so that they can continue those changes as a way to improve patient safety. Jena said the findings showcase "how increased focus, attention, and cognitive bandwidth, all of which happen when people are being monitored, could lead to measurable improvements in patient outcomes" (Punke, Becker's Infection Control & Clinical Quality, 3/20; Barnett, JAMA Pediatrics, 3/20; Bakalar, "Well," New York Times, 3/20; Lagasse, Healthcare Finance News, 3/20; Rapaport, Reuters, 3/20).
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