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Just as the litany of potential health care emergencies can change and grow from year to year, so do the standards produced by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This year’s standards are rife with new language. (The new standards can be found on JCAHO’s web site: www.jcaho.org/standards_frm.html.)
"We have tried to write the standards in such a way that hospitals would be able to identify what might be unique to their situation, as conditions vary in different parts of the country and in different types of hospitals," notes Paul Schyve, MD, senior vice president.
Things can happen to effect changes in the standards, says Schyve: For example, there could be changes in the community environment. "For instance, bioterrorism has now become evident, and the health care system needs to develop preparedness for it, yet a few years ago essentially no one would have been thinking about it," he explains. "At the same time, we are constantly developing new ideas and knowledge about how to do our jobs more effectively."
"The changes that stand out most this year talk about coordinating more with the community," adds John Fishbeck, assistant director of the division of research, standards, and development at JCAHO. "In the past, expectations were that plans be in place, but we did not address how to integrate those plans with the community at large — other hospitals, law enforcement, the Red Cross. That’s where the weakness was," he adds.
"As people started to look at the potential risk of bioterrorism, for example, they realized that it is not just the health care organization that can make changes to be prepared for it," Schyve says. "It doesn’t help the hospital to have special procedures to use when suddenly it has an influx of people with exposure to a bio element, and, in fact, no one has communicated to them that something just happened at a nearby stadium and people were exposed. Another example was the recent flooding in Houston; while individual hospitals may have had plans in place, in this situation, we had a number of hospitals that had to be closed for a period of time," he points out.
"This was something people had not focused on before; what if a whole bunch of hospitals closed down all at once?" Schyve asks. "We don’t expect that to happen, but it leads people to see that we need to think a little differently. Individual hospitals can no longer afford to think only within their own silo.’"
In order to adequately respond to the larger challenges, organizations must be well-prepared far in advance of the potential event, Fishbeck notes. "Meetings need to be going on so everyone knows each others’ strengths, and what they can bring to the table," he says. "In Salt Lake City, for example, people are already prepared for the upcoming Olympics. They have gotten together, conducted drills, worked with communications, transfer agreements, and so forth.
"It’s true there are risks you realize ahead of time may occur, like a tornado, so your organizations can work together on how they would deal with that," Schyve explains. "But there are also the risks you can’t predict, when something unexpected or more general occurs. It almost requires you to make a community plan for the unpredicted. But then, that’s the idea of emergency management: Find the key people and get them together. Then, if you know who these people are, you have to have your emergency management system in place."
That includes communication, Fishbeck says. "You must have a communication system designed that’s consistent with your community — an incident command system, if you will."
That system should involve public health officials, the Red Cross, the fire department, police, the coroner’s office, and agencies that provide food, supplies, and utilities. "In short, everything that the hospital needs," he says. Once everything is in place, says Fishbeck, make sure the plan is kept current. "Things change, personnel change, the location of the door to the emergency room could change."
"You should regularly review the plan with relevant parties, even if no changes are needed," he insists. "That’s one way to make sure this does not simply become a dusty book on a shelf. Second, make sure that whatever you have put in there is still applicable. And always incorporate new information — new knowledge, new equipment, whatever."
"In our standards, we talk about reviewing a plan at least annually — not only internally, but externally," Schyve says. "Make sure telephone numbers are up-to-date, that your contacts are still the same people. Also, two drills a year have to occur, and you should critique and learn from them," he adds.
For more information, contact:
• Paul Schyve, MD, Senior Vice President, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oak-brook Terrace, IL 60181. Telephone: (630) 792-5000. Fax: (630) 792-5005.
• John Fishbeck, Assistant Director, Division of Research, Standards Development, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000. Fax: (630) 792-5005.