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Appeals court elucidates how far investigation goes
A recent federal appeals court decision clarifies how far an investigation into "disruptive behavior" goes under the Health Care Quality Improvement Act.
The case involved a physician who was investigated following a nurse's complaint that he had threatened her. The medical executive committee suspended the doctor's privileges, while another committee evaluated the allegations. The executive committee, based upon the investigating committee's report, was going to reinstate the doctor's privileges with his assent on certain conditions, but he rejected those and voluntarily resigned. The hospital then reported him to the National Practitioner Data Bank, believing the investigation had yet to be concluded. The physician appealed the decision, but ultimately the court sided against him, saying the formal investigation had not been concluded when he resigned.
"We've not had any guidelines on what this means. There hasn't been case law in this," says Alice Gosfield, a Philadelphia-based attorney and consultant specializing in quality improvement. "So what this case stands for is the proposition that as far as the courts are concerned, or at least this court looking at this case, the investigation is not over until the medical executive committee takes final action.
"How far does an investigation extend? Say for instance if you leave and they've not actually convened, they haven't made a formal investigation with regard to what they're going to do to you, did you leave before the investigation, did you leave when the investigation was concluded? His argument was they had concluded what they were going to do because he left. And the hospital said no, we were on the glide path of corrective action. And the court said the investigation isn't over until medical executive committee concludes its position but it had not done."
NQF reviews Nursing Sensitive Care Measures
In 2005, the National Quality Forum endorsed a set of national standardized performance measures to assess nursing in acute care hospitals and the role of the nurse in patient safety and health care quality. Now that list is being reviewed and updated.
The measures NQF initially established were tested and analyzed by The Joint Commission in 2007 and 2008. NQF is looking at the updates recommended through that process and sought public comment on the proposed updates, which include clarification of data collection approaches, specifications and exclusions for pressure ulcer staging, and clarification of definitions. Stay tuned for the final version.