Who died and made Joint Commission "God"

[1Tulip]

I am not saying that I work in the world's greatest hospital. But I've been a nurse for 38 years and it's the best one I've ever worked in. Have you ever worked in one that didn't sometimes make you crazy????

I live in a not so densely populated area of the country. Our chachement area covers three states. If all those areas are surveyed, it is clear that they are significantly under-bedded. Joint Commission has been on our case for several years. They found problems they wanted fixed. The hospital fixed them, but not in a way that JC apparently wanted. It's been like playing a game where every time you get the ball, they move the goal line.

We were informed last week that statistically, a hospital that has run the string out as far as we have does not pass. I've been in on the Quality efforts that have been made, and the extensive staff training that has gone on. Our hospital exceeds standards in so many ways it's rediculous.

But here's the bottom line. Joint Commission is crazy enough to essentially close a hospital that provides over 75% of the operating rooms for this huge area. The only trauma ER. We do the heart caths and have the interventional radiology. We bring the technology that keeps people alive, while the other hospitals are small and colloquial, though also very good. AND we're going into a flu season where we KNOW the area hospitals have a serious shortage of ventilators. (There have been meetings among the hospitals to develop action plans for the conventional and H1N1 flu.)

They don't care if my neighbor's kid gets hit by a car and there isn't any place to take her. The next gaggle of surveyors that probably live in other places like Nebraska or Missouri or whatever. A surveyor that lives in Atlanta doesn't care if my mother in law gets the flu and there are no ICU beds to support her when she gets pneumonia.

This is nuts! If the place was a snake pit... I'd be the first one to say it should be shut down. But in our state, we KNOW there have been seriously deficient places that were fiscally poorly run and in decline but they did NOT lose their accreditation.

Would they close us down and give no thought to the immediate public health crisis they create? I think they would.

They are unelected, unaccountable and so powerful I think they are dangerous.

[Ginger's Mom, MSN, RN]

No, I think Medicare appointed JC God. Medicare has a long history of empowering other agencies to do their job. Pro organizations to denials, Medicare intermediaries to do out patient denials. This is one the reasons that I do not want a government health care mandate.

Sounds like your organization has done the right things. It would not be politically right to put a hospital out of business in this economy. I wish you the best of luck.

[1Tulip]

Just talked to my daughter who is an anesthesiologist. JC made them put a ringy-dingy bell in each OR room. Circulating nurse rings the bell and everyone stops and does their little final check. Maybe JC hasn't told us about the little bell and that's what they're going to fail us on.

If only they were consistent!

Has anyone had a surveyor hide their name badge and walk off with a chart? Yep. Now the rule in our hospital is that the charts have to be in our line of sight at all times. Not the confused and impulsive patients our unit deals with. No, they can be outside of our peripheral vision. But the charts, THOSE we have to watch at all times. The chart rack!!! Can you believe this is how they improve patient safety!!!!! (Yes, of course privacy is important. But how can I keep my eyes on the charts when my brain injured patient is half-way over the side-rails?)

If a bunch of people die in our area as a result of a bad decision by JC, I swear I will contact the lawyers to take them down in a class action law-suit.

[Ginger's Mom, MSN, RN]

We have had surveyors walk in the emergency room before the appointed time. I don't believe that is right. That being said, this is just a small part of the aggravation of running a hospital.

How does your hospital do on the Core Measures, that weights heavily on how Medicare and JC sees you. You would not believe the baloney that hospitals have to do to submit this data. You have to answer ridiculous questions and then when audited which happens each quarter you have to defend the documentation. It is a total time waster yet if you don't comply you loss 2% of Medicare funds.

The state is even worse, in my state instead of filing paper work, we had to hire a computer program to write a program so we can submit our data electronically. Worse is you have to review the same charts you did for Medicare but apply different rules for the state.

And if your hospital hasn't been hit yet, Medicare is doing a RAC audit. If your t's are not crossed and I's are dotted you have to give back Medicare money that your hospital has already spent.

Perhaps the JC is being so hard since Your home state has been targeted as high cost low quality state.

[RNontheroad]

I have been feeling the same way about JC for some time. It seems they have been the "only fish in the big sea" for so long, that they have become rather demanding and sometimes unreasonable. Hopefully as DNV becomes more mainstream and hospitals start using them as an alternative means of accredidation, it will put JC back in check.

[1Tulip]

Our Core Measures are a mixed bag. On AMI we are superb and way beat the national average in door to cath-lab times. Our dicubitus rates are very low. When it comes to Pneumonia and CHF... we're near average, I think. With SCIP, I think we were below average but are making head-way.

I had not thought of that business about us being a high cost state. We have challenges that other states don't have... but that's true of lots of states. The crime is in instituting cookie-cutter standards and solutions to every hospital everywhere in the nation.

Oh, my... we are sooo tired of this. Our manager and supervisor were in tears last week, just SURE that they were going to be fired. (Like that would really help us pass!)

How long can you hold up under this kind of tension. Just trying to give care when we are understaffed is tough enough... we had no vacancies on our unit, were down 2 RN's and 2 CNA's. We all started the day with 6 patients, and ER was trying to send up admissions. And in all of that, we are supposed to have PERFECT documentation, clean and tidy rooms, happy patients, label all IV tubing, keep clutter out of the hallway even though they make us use those mobile computers which cannot stand in the hallway... foam in/foam out, don't just know the fire evacuation route... you have to know 2 evacuation routes, know where in the chart every conceivable piece of information is, secure the charts at all times... Aaaaaach! Maybe we should start a thread "Stupid and Impossible things Joint Commission makes us do".