New Oryx program: Get your ED on board

JCAHO’s new Oryx program will evaluate hospitals, including the ED, by using continuously collected data on various performance measures. The ED is in a prime position to benefit from the Oryx program, stresses Stuart B. Shikora, MD, FACEP, a physician surveyor with JCAHO. "ED managers should be leaders within their institution in finding and advocating for studies that reflect on their performance," he says.

Previously, JCAHO assessment was based on a "snapshot" of performance improvement, consisting of a single report generated for a survey. With Oryx, data will be recorded month by month, with results tabulated each quarter for an annual report. The long-term goal is to improve care by identifying trends and outlying cases, and to allow hospitals to address performance issues between surveys.

Currently, Oryx is directed at the hospital level. "When we go in and do a survey, we ask how you are prepared for Oryx, and what your plans are for the next year or two," he explains. "At this point, it’s more of a question asked at the leadership conference, not the departmental conference."

However, it’s strategic to get involved with Oryx now, says Shikora. "Managers should be proactive and read up in the literature about the indicators. Get on the bandwagon early," he advises.

An indicator is part of a performance measurement system; it is selected from a list published by the Joint Commission. Examples of indicators include the time between ED arrival and CT scan, or the time between identifying a patient’s chest pain as a heart attack and the administration of thryobolytics.

The first step is to identify Oryx indicators that involve the ED. "ED managers should log onto the JCAHO Web site to find several topics that they think would be of value to their department to pursue," says Shikora.

Oryx measures that affect the ED include adverse drug reactions, acute MIs, antibiotic use, congestive heart failure, diabetes, equipment failures, conscious sedation, medication errors, pain management and pneumonia, says Kathleen Catalano, RN, JD, senior consultant for the Greeley Company, based in Marblehead, MA.

Find out what indicators your facility has chosen to pursue, urges Catalano. "As of this year, you must select four indicators representing 25% of the patient population. If you choose trauma patients as an indicator, it doesn’t mean that 25% of ED patients are trauma patients, it means that 25% of the hospital’s patients come through the ED," she explains.

The ED is a prime candidate to pursue for many of the Oryx indicators, Shikora emphasizes. "Surveyors look at the ED as a microcosm of the hospital. Given that, department managers can become leaders in the hospital by identifying some of the more interesting or perhaps problematic standards, which can then be improved."

Understand how data is reported. To fully benefit from Oryx, you need to be able to understand statistical process control. "There is a variety of control chart types which reflect different types of data, so you need to be familiar with the way the data is accumulated and reported," says Shikora.

Once the core measure data is collected for the indicators you’ve chosen, JCAHO surveyors will want to see how you plan to improve. "Once you have the data and know how you’re stacking up, then you’ve got to take action," says Catalano. "Right now JCAHO has the prerogative to ask how you’re doing. By the time 2001 rolls around, surveyors will want to see your action plans."

However, at this point surveyors will ask only if you are reporting to Oryx and what indicators you’ve selected. "Right now, the hospital is allowed to choose its indicators. So people are measuring the indicators that they’ll get 100% compliance on, and won’t choose things which they won’t do well on," says Catalano.

At a later date, hospitals will be assigned indicators. "The JCAHO will effectively be saying, you don’t have a choice this time.’ This will actually give them some real data," says Catalano.

Generally, to measure an indicator takes 3-6 months to plan and a year to gather data and report it to central reporting facility, says Shikora. "At that point, data will be pooled with other institutions. That will give you a clear idea of how your ED is performing when stacked up against other, comparable facilities," he says.

The program will allow EDs to compare outcomes, to identify outstanding and poorly performing EDs. "Oryx is a valuable data-gathering tool, allowing an institution to compare itself to others of comparable size and to get feedback," says Shikora. "Historically, data haven’t been collected on a nationwide basis, which would allow facilities to compare themselves to peers. Until now, it’s only been done through chain hospitals or specialty organizations."

The primary goal of Oryx is continuous quality improvement. "By obtaining data quarterly, JCAHO will be able to show continuous improvements," says Catalano. "Then you can see how it’s affecting you across the board, across the country, with other hospitals reporting on the same indicator. Everybody will have to turn in the same data, so we’re going to find out what’s really going on out there."

Editor’s Note: For more information on JCAHO standards, contact the Interpretation Unit, Department of Standards at One Renaissance Boulevard, Oakbrook Terrace, IL 60181. Telephone: (630) 792-5900. Fax: (630) 792-5942. E-mail: Internet: The Interpretation Unit receives approximately 30-50 e-mails, letters, and faxes and 350-400 phone calls per day. The unit encourages organizations to send their questions via e-mail, when possible, if a documented response is required. Individuals requesting a standard clarification should have the following information available: Name and title of person requesting information, name and type of organization, office phone, e-mail address, and a description of the issue, including the applicable manual and standard.

Source: For more information about the Oryx program, either call the Oryx Information Line at (630) 792-5085, or e-mail questions to