For years, experts thought that if a physician was well-trained in the hospital setting, he or she could transfer those skills to the ambulatory setting with no adverse effect on patients. An editorial from the Annals of Internal Medicine points out the differences between those care settings. The author, Robert M. Wachter, M.D., describes four major differences between hospitals and ambulatory clinics:
- Nature of errors that occur
- Patient-provider relationship
- Differing organizational structures
- Amount of scrutiny by regulators and organizations like The Joint Commission
I am heartened by discussions of this caliber which reflect a growing interest in understanding the true nature of medical errors and, thereby, the most appropriate patient safety efforts in the ambulatory setting.
The Joint Commission continues to focus its efforts on providing a rigorous and valid assessment of the care you provide your patients. Whether you’re talking about our Standards Improvement Initiative or the 2008 National Patient Safety Goals, every effort is being made to recognize the distinct care processes of an ambulatory clinic or a physician’s practice.
Dr. Wachter reports that clinics have clear advantages over hospitals with respect to patient safety. Do you agree? Read the article at www.annals.org/cgi/content/full/145/7/547.
Michael Kulczycki, MBA, CAE
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As part of the Standards Improvement Initiative, three new chapters have been posted for review and comment on The Joint Commission website. Ambulatory care and office-based surgery professionals can offer their feedback on proposed revisions to the current Management of Human Resources, Management of the Environment of Care and Medication Management chapters. Feedback on proposed revisions to these chapters will be gathered for the next several weeks.
According to Carol Gilhooley, project director, SII, “Anecdotally our ambulatory customers are telling us to be more specific with respect to services. In other words, only the services they provide should be in their manual. We’re working to create a database to allow this to happen. We are planning to use more service-specific language.
“Another issue is the amount of documentation,” Gilhooley adds. “We have been sensitive to this in our recommendations. We are striving to require documentation only when it is most essential—when compliance is not observable in other ways.
Improvements are targeted to go into effect January 2009 for the ambulatory care and office-based surgery programs. For more information about SII, send an e-mail to standardsimprovement@jointcommission.org.
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Mark R. Chassin, M.D., M.P.P., M.P.H., has been appointed to lead The Joint Commission as its next president, effective January 1, 2008.
Dr. Chassin is the Edmond A. Guggenheim Professor of Health Policy and chairman of the Department of Health Policy at Mount Sinai School of Medicine, New York, and executive vice president for Excellence in Patient Care at The Mount Sinai Medical Center. Prior to joining Mount Sinai, Dr. Chassin served as commissioner of the New York State Department of Health. He is a board-certified internist and practiced emergency medicine for 12 years.
Dr. O’Leary, who has led The Joint Commission for the past 21 years, will become president emeritus on January 1, 2008. More information about Dr. Chassin is available in the October issue of The Joint Commission Perspectives.
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The new 2008 National Patient Safety Goal Requirement 3E (Reduce the likelihood of patient harm associated with the use of anticoagulation therapy) is not applicable to practices accredited under the Office-Based Surgery Accreditation Program. Effective September 14, 2007, Requirement 3E was rescinded for OBS organizations. However, it is applicable to ambulatory facilities accredited under the Ambulatory Health Care Accreditation Program. See the updated 2008 NPSGs for OBS and ambulatory care organizations.
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Ambulatory care organizations and office-based surgery practices often can reap the benefits of Joint Commission accreditation while meeting state licensure requirements. Currently, a number of states—25 for ambulatory care and 14 for office-based surgery—recognize Joint Commission accreditation in whole or part in fulfillment of regulatory requirements.
“These are important partnerships,” says Jennifer Hoppe, associate director of State Relations. “Recognition is a win-win proposition for the states, their licensed organizations and The Joint Commission.”
The Joint Commission staff seeks out state agencies and meets with their representatives on a regular basis. Hoppe and The Joint Commission’s office-based surgery team are closely watching a new law in New York that will require accreditation for physicians practicing in office-based surgery facilities. Details will follow in an upcoming issue of Ambulatory Advisor.
Recognition of or reliance on different types of service providers varies by state. A current list of states recognizing Joint Commission accreditation is available online.
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Ambulatory care and office-based surgery professionals can collaborate to develop performance improvement solutions through The Joint Commission’s WikiHealthCareTM application. This free, internet-based forum can be accessed through a link on The Joint Commission’s home page, or at wikihealthcare.jointcommission.org.
Use of the test site is available at no cost. The content developed on the site is non-proprietary, open source information (i.e., owned by the community of contributing users). All users participate as individuals, not as representatives of their organization. Participation has no impact on an organization’s accreditation status.
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The Joint Commission’s Quality Check® website now includes organizations that are not accredited by The Joint Commission as well as Joint Commission accredited organizations. Joint Commission accredited organizations are easily identified by The Joint Commission’s Gold Seal of Approval™. This is the first listing of its kind. The addition of non-Joint Commission accredited organizations provides consumers with more information about where to go for their health care needs. Quality Reports will only be available for organizations that are accredited by The Joint Commission.
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Q: Does a radiologist need to over-read all X-rays in ambulatory care?
A: “There is no Joint Commission requirement for over-reads by a radiologist, regardless of whether the original reading is conducted by an onsite radiologist or a teleradiology firm,” says Cherie Ulaskas, associate director, Standards Interpretation Group. “It is your organization’s decision. The Joint Commission does not specify or mandate clinical practice. Your organization must define its clinical practices based on its policies and procedures, law, regulation, standards of
practice and patient need. Anyone who has been deemed competent and given privileges by your organization to read X-rays may do so.”
E-mail your Ask the expert question to abrown@jointcomission.org.
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The Joint Commission has discontinued track record requirements for organizations new to the accreditation process. Read more in the September issue of The Joint Commission Perspectives.
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Publication
Applied Tracer Methodology: Tips and Strategies for Continuous Systems Improvement profiles health care organizations that have effectively used tracer methodology. One case study features the Private Diagnostic Clinics at Duke University, where Johnetta James, R.N., M.S.N., director of Accreditation and Patient Safety for the clinics, has been conducting mock tracers for several years. Visit the JCR webstore.
Education program
Ambulatory Care: Accreditation Essentials
Nov. 13-14, Garden Grove, CA..
Register at www.jcrinc.com, or call toll-free (877) 223-6866.
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- 14th Annual Ambulatory Surgery Center Conference, Chicago, Ill., Oct. 18-19
- American College of Chest Physicians, Chicago, Ill., Oct. 22-24, Booth 482
- American Society of Plastic Surgeons, Baltimore, MD., Oct. 28-30, Booth 410
- Medical Group Management Association, Philadelphia, Pa., Oct. 28-30, Booth 635
- Radiological Society of North America, Chicago, Ill., Nov. 25-29, Booth 1266
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Michael Kulczycki, executive director
(630) 792-5290
Mike Dye, senior associate director
(630) 792-5259
Darrell Anderson, business development specialist
(630) 792-5292
Account representative
(630) 792-3007
Standards Interpretation Group
(630) 792-5900
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