RUS to look at ambulatory care, behavioral health

You may not be able to tell when they’re coming, but at least you’ll know where the Joint Commission on Accreditation of Healthcare Organizations’ random unannounced surveys (RUSs) are focused. The Joint Commission recently announced the topics for RUSs, in terms of highest priority.

Five percent of accredited organizations in the targeted areas will be the focus of an RUS, according to a notice from the Joint Commission.

The RUS is separate from the scheduled triennial surveys, but they won’t happen back to back. An organization can be selected between nine and 30 months after its full survey and will not receive any prior notice that a surveyor is coming. (One good note: The surprise inspection is free.)

The surveyor will include a review of both "variable" and "fixed" performance areas. Providers subject to the surprise surveys are ambulatory care, behavioral health, home care (including pharmacies), hospital, and long-term care.

Once you’re chosen, surveyors first will assess organization-specific performance areas based on the organization’s last accreditation survey report, any complaint or performance data received since the last full survey, and other feedback and findings discovered on site during the RUS. Those are the "variable" elements. One goal of looking at those elements is to verify sustained resolution of Type I recommendations.

Surveyors also will assess the "high-risk" performance areas that the Joint Commission determined for each specific type of provider. These are the "fixed" elements. The Joint Commission reports that these elements were chosen for a variety of reasons, in particular, a high percentage of Type I recommendations, complaints, and sentinel-event statistics. Concern from the public could have prompted an element’s inclusion also, even if there were no internal indicators of the problem.

The elements are prioritized "based on the degree of actual or perceived risk to patient care and noncompliance, with relevant standards in each area specific to the health care setting being reviewed," the Joint Commission says. When a surveyor doesn’t have time to look at all the fixed elements, he or she will start at the top of the list and work down, the Joint Commission says.

These are the top elements for unannounced surveys in 2002, in order of priority:

Ambulatory care.

Credentialing and privileging of licensed independent practitioners, improving performance, implementation, medication use, and competence assessment.

Behavioral health.

Qualifications, competencies, and clinical responsibilities; special procedures; initial screening and clinical assessments; assessment for discharge-planning care decisions and reassessment; and medication use.


Management of the environment of care — planning; initial assessment; patient-specific data and information; medication use; and orientation, training, and education of staff.

Home care — home health.

Home health planning and provision of care; human resources management; home health — patient assessment; contract management; and aggregation and analysis.

Home care — equipment management.

Equipment management — planning and provision of care; equipment management maintenance, testing and inspection; equipment management — patient assessment; equipment management — specific patient rights; and equipment management — specific patient education.

Home care — pharmaceutical services.

Pharmacy — planning and provision of care; pharmacy — maintenance, testing, and inspection; pharmacy — patient assessment; pharmacy — drug preparation and dispensing; pharmacy — patient-specific information.

Home care — hospice services.

Hospice — planning and provision of care; hospice — patient assessment; hospice maintenance, testing, and inspection; hospice-specific patient rights; and hospice — infection control practices.

Long-term care.

Assessment; planning and providing care; implementation; orientation, training, education, and competency; and credentialing.

Long-term care — subacute care.

Assessment; planning and providing care; orientation, training, education, and competency; credentialing; and resident-specific data and information.