ED Accreditation Update

Higher-level certification available to hospitals that that meet more rigorous standards in caring for patients with heart failure

Program recognizes emergency services as key component of HF care

Hospitals that want to distinguish themselves as centers of excellence in the care of heart failure (HF) have a new avenue to pursue. On July 1, the Oakbrook Terrace, IL-based Joint Commission (JC) launched its Disease-Specific Care Advanced Certification Program in Heart Failure. The program, which is being offered in collaboration with the American Heart Association (AHA), incorporates additional clinically-specific requirements over and above the core framework of requirements for Disease-Specific Care Certification, explains Jean Range, MS, RN, CPHQ, executive director, Disease-Specific Care Certification, at the JC.

The July launch of the program actually represents phase two of an initiative that began in 2009 with the requirement that hospitals participate in the AHA's Get-With-The-Guidelines program, adds Range. To be eligible for the higher-level HF certification program, hospitals must have demonstrated bronze-level achievement in the AHA's program, consisting of 85% compliance on the quality measures in that program, she says. In addition, the hospital's HF program must include either a hospital-based and hospital-owned outpatient HF clinic, or it must have a collaborative relationship with cardiology practices.

"We are very excited about the fact that we have been able to incorporate additional requirements into this program relating to transitions of care and care coordination," says Range, noting that these areas tie into specific requirements mentioned in the Affordable Care Act that seek to prevent avoidable readmissions related to HF.

"From our point of view, emergency services are a key component of HF care in hospitals because this is where many of these patients are presenting," says Range. "EDs are playing an active role in identifying patients at increased risk for readmissions, and when patients are not admitted, actually coordinating their care."

Recognize symptoms, implement guidelines

A key focus area for on-site evaluators tasked with observing whether hospitals qualify for advanced certification will be reviewing whether ED physicians are making the appropriate diagnosis, says Range. This is important because it is not always evident that a patient is suffering from HF, but being able to recognize the signs and symptoms of the disease is critical to implementing effective care interventions. "The expert panel that we used to come up with our requirements for the program talked extensively about this," says Range. "The first line of care that is so important to these patients is going to be the ED."

Evaluators will also be looking for evidence that clinical practice guidelines for HF are in place and actually embedded in the care processes. The program has integrated the "2009 Focused Update: American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Treatment of Heart Failure in Adults." However, making sure that best practices are actually being used is a tall order for many organizations.

"The most frequently cited standard for certification relates to the consistent implementation of clinical practice guidelines," says M.J. Hempel, MPH, MBA, senior associate director, Disease-Specific Care Certification at the JC. "Guidelines and protocols and standing orders are adopted by organizations, but sometimes they are not implemented, [resulting in non-compliance.]"

Achieving adherence to disease-specific guidelines can be particularly challenging in the ED where providers are dealing with all different types of patients in a fast-paced setting. Range says this is one of the reasons why the JC always advises organizations that are contemplating certification for any disease state to secure the endorsement and support of the senior executive leadership as well as the senior executive clinical leadership. "This is very complex. There are so many different stakeholders and details that have to be reinforced constantly that it just turns out to be the most challenging aspect of certification," she says.

Quality is top priority

Currently, hospitals interested in pursuing advanced certification can expect to pay about $5,000 per year for the two-year certification period, says Range. This covers the expenses associated with the on-site reviews that will take place at the beginning of the process, and annual fees. While the program may, indeed, ultimately save hospitals revenue, Range emphasizes that what prompted the JC to develop the program was a drive to improve quality.

"We were very interested in the section of the Affordable Care Act that focuses on HF readmissions, and once we spoke with expert panel members, they confirmed that this is a big issue," she says. "We think the timeliness of this program is closely aligned with the focus that all hospitals are placing on this issue."

Editor's note: For more information on the Joint Commission's new Disease-Specific Care Advanced Certification Program in Heart Failure, contact program administrators at: dscinfo@jointcommission.org.