Survey Field Report: Sending out an SOS

How four rooms in the middle of a hospital made a summer of surveys go more smoothly

It was a "perfect storm," says Paula Swain, director of accreditation and regulatory for Novant Health/Presbyterian Healthcare in Charlotte, NC. In the first week of June, it became clear that between mid-July and August 20 there would be both Joint Commission and Centers for Medicare & Medicaid Services (CMS) surveyors on the grounds of 607-bed Presbyterian Hospital in Charlotte, potentially at the same time. It's the kind of realization that can make one's heart skip a beat.

But there wasn't time for beat-skipping. Swain and her colleagues had to figure out a good way to get through a difficult situation without panic and with an eye always on the ball of quality, safety, and success.

That Swain is still talking — raving — about how her team performed is a testament to hard work, a degree of luck, and some serendipitous decision-making.

Indeed, just tweaking the way they physically arrange for survey made a huge difference.

Serendipitous event number one: Leadership had all participated in Hospital Incident Command Systems (HICS) training, emphasizing the benefits of having a command center for big events. "We applied that training to what we called the War," Swain says. The hospital also had to undergo biannual health department visits where two teams came, one starting at the top of the hospital, one at the bottom. They'd eventually meet in the middle. "We figured if we were in the middle vertically and horizontally, it would be easier."

Serendipitous event number two: They had just opened a new public safety wing in the dead center of the hospital. Setting up a suite of those rooms as a command center seemed like a great idea. Each room would have a function, a staff, and appropriate supplies. (For a list of rooms and functions, see box, below.) All would be linked with a conference line that was kept constantly open so that all interested parties could keep track of where surveyors were, what they were looking at, and whether there was anything they found that needed to be printed, fixed, or located.

The public safety classroom was used for check-in; the command center room was used for monitoring communications and ensuring tasks were complete; the squad room was used to dispatch people to fix problems as they were found; and the review room was used for document management. The nursing classroom down the hall was used for the surveyors to check in, hang out, and meet their escorts.

When a surveyor, out with a scribe and escort, found issues with a room, the call was dispatched through the command center and the task was picked up by staff in the squad room. Often, before a surveyor even left a room, whatever issue they found — a stained ceiling tile or broken switch —was in the process of being fixed by staff who seemed to be able to read minds. "When they pointed, someone with a ladder would appear," says Swain. If a particular kind of patient chart was required, then the staff in the review room would find it, print it, and take it to the command center for review to ensure the file was complete. If it wasn't, whatever it was missing was found. Then and only then was it sent on its way.

Everyone was in a central location. Previously, Swain says they used a single conference room with a long table. There was a crowd, a noise level, and a panicked busy-ness that made getting done what had to get done hard. Three people might hear something was needed and all would get up to do it. Under the new system, the people in charge of the labor pool would dispatch a single person.

A little shifting, but little hassle

The new wing was designed to have this command center structure, Swain says. There was a door into the command center, and a door from that room into the public safety office and the squad room. The people who usually used the squad room to get their coffee and go over their files were imposed upon, and classes that were planned for the public safety office were cancelled or moved. But aside from that, no staff were shoved out of the way or made to double or triple up to make room for the new arrangements.

Further, the four-room setup with designated people in specific roles meant that no extra staff had to be called in. Swain says Novant Health offered to send assistance for education and scribing.

In the old system, there was a rolling cart with phones, computers, printers and other equipment that was brought into the conference room for the masses to fight over. In June, when a small group of surveyors from the state were on site, they would ask for documents or charts. "I kept looking for staplers and tape and could never find it," recalls Swain. Now, each of the four rooms has its own box of general office supplies.

What had been like an ant hill kicked by a careless walker was now orderly and fairly seamless. Part of that was because of regular mock survey drills Presbyterian held. At these, sweepers would come in at 7 a.m. They were assigned by unit to check rooms, find the best charts, and ensure that anything missing — signatures, dates — was completed. They would call in any needed work and follow up on those orders. "It was real-time communication and practice," says Swain. These drills lasted just an hour, but they paid dividends. "We'll never change this. People go to their posts and know what to do."

Next month, HPR will look at some of the direct results of the Joint Commission survey at Presbyterian Hospital, and the lessons learned.

For more information on this topic, contact Paula Swain, Director of Accreditation and Regulatory Novant Health/Presbyterian Healthcare, Charlotte, NC. Telephone: (704) 384-8856. Email:

Work room descriptions — Summer of Surveys

Public Safety Classroom
• Check in for all roles.
• Conference Line Control Station to:
Facilitate, record, dispatch
Support volunteer staff
Create workstations for problem solving

Command Center
• Manage communication flow,
• Make assignments,
• Assure all sites reviewed
• Review scribe notes, conference calls from recorder and track issues to completion
• Close loops

Squad Room
• Place for service line experts (hospital operations leads)
• Act on issues referred to it
• Place for scribe/escort teams to join surveyors

Review Room
• Document management
• Run document to surveyor room after approvals
• Type scribe notes

Nursing Classroom
• Surveyors' comfort
• Keep hospital staff linked to surveyors
• Provide material check in