Hospital patient mortality drops during Joint Commission surveys, study finds

Patients admitted to the hospital during an unannounced Joint Commission survey have lower 30-day mortality rates than those patients admitted three weeks before or after the unannounced survey, according to a study published Monday in JAMA Internal Medicine.

The Joint Commission drops by unannounced to accredited hospitals every 18 to 36 months to examine the hospitals' patient safety protocols, which often puts hospital staff on high-alert and on their best behavior.

"The stakes for performance during a TJC survey are high: loss of accreditation or a citation in the review process can adversely affect a hospital's reputation and presage public censure or closure," the study reads.

To measure the effect these unannounced inspections have on patient safety, researchers from Boston-based Harvard Medical School and the Harvard T.H. Chan School of Public Health analyzed Medicare admissions at 1,984 surveyed hospitals from 2008 through 2012 in the period three weeks before to three weeks after the surveys. They adjusted for patients' sociodemographic and clinical characteristics.

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Across all hospitals, patients admitted during an inspection week had, on average, a 1.5 percent lower risk of dying within 30 days of admission compared to patients treated in the three weeks before or after a survey. At teaching hospitals, the decrease in mortality during survey weeks was more significant — 5.9 percent.

The study's authors said the most probable reason for the decrease in mortality during survey weeks is the "heightened scrutiny during visits" and the physical presence of surveyors, similar to how the Hawthorne effect contributes to better hand hygiene compliance.

"These changes suggest that some aspect of predictable behavior change associated with TJC surveys might improve the quality of inpatient care," the study authors concluded. While 1.5 percent isn't a large drop, "even changes of this magnitude throughout the year could theoretically have a significant public health impact," they wrote.

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