Patient Mortality During Unannounced Accreditation Surveys at US Hospitals

Abstract

Medical error is a significant cause of preventable mortality in US hospitals.¹ To ensure compliance with high standards for patient safety, The Joint Commission (TJC) performs unannounced on-site inspections (ie, surveys) at US hospitals every 18 to 36 months as an integral part of their accreditation process.² During these week-long inspections, TJC surveyors closely observe a broad range of hospital operations, focusing on high-priority patient safety areas, such as environment of care, documentation, infection control, and medication management.³ 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.^4-6 This possibility can be especially important for large academic medical centers, whose reputation provides significant financial leverage in their local market.⁷ Hospital staff are keenly aware of their behavior being observed and reflecting on their institution as a whole during TJC surveys.⁸ This pressure has created an entire category of staff training in many hospitals around “survey readiness.”^9,10