ED Accreditation Update

New scoring process: 'quality, not quantity'

The Joint Commission has released a statement that effective Jan. 1, 2009, there will be new simplified scoring and decision processes for all accreditation and certification programs that "better reflect an organization's performance regarding compliance with Joint Commission standards and elements of performance [EPs]."

"We've tried to eliminate some of layers of complexity," explains Kevin Hickey, MSA, director of survey scheduling and support. At press time, The Joint Commission had not finalized all of the elements of this new process, but perhaps the most significant for ED managers and hospital leaders was the "last piece," which he expected to be resolved in October.

That piece involves what The Joint Commission calls its accreditation "threshold." At present, that threshold is based on the total number of findings reported by the surveyor. "Once they have determined certain standards to be noncompliant, we count those up," Hickey explains. "In the current model, we have pre-established thresholds; and based on the volume [of noncompliance to standards], we issue either conditional accreditation or preliminary denial."

The current model, he continues, requires accreditation decisions based solely on the quantity of the findings, no matter whether the violations are critical to patient safety or not. "What we are proposing is rather than focusing on the total count, we want the focus to be on the standards we find have a direct impact on the quality of care and patient safety," Hickey explains.

So, for example, more weight would be given to most of the National Patient Safety Goals. Also covered, says Hickey, would be a new standard, PC.03.01.01, EP 6, covering appropriate monitors of physiological status for patients under sedation; the new standard for response to pain assessment, PC.01.02.07 EP 1; and the requirement for emergency medicines to be readily accessible, MM.03.01.03, EP 2.

"The balance of the standards, such as those covering planning and evaluation, will be labeled as having 'indirect impact,'" Hickey continues. "They are important, but many are not a critical issue with the patient today."

In The Joint Commission's program governing hospitals, Hickey says, about 20% of the EPs have been given this label. "The focus in the future would be more on the direct impact group, where noncompliance has the potential to have immediate impact on quality of care and patient safety," says Hickey, adding that the new rankings will be included in the 2009 accreditation manual, to be posted online until hard copies can be distributed.

Emergency medicine experts are pleased with the new approach. "It's always good news for ED managers and hospital leaders when the accrediting and standards bodies value quality over quantity," says James J. Augustine, MD, FACEP, director of clinical operations at Emergency Medicine Physicians, an emergency physician partnership group based in Canton, OH. "I support that philosophy."