ED Accreditation Update: SII simplifies language, structure of standards
ED Accreditation Update
SII simplifies language, structure of standards
Initiative doesn't include intro of new standards
While ED managers have awaited the results of The Joint Commission's Strategic Improvement Initiative (SII) with some trepidation, their fears by and large might have been unfounded based on some early comments. In fact, the introduction of the revised standards might actually help dispel some mistaken beliefs.
For example: SII does not introduce any new standards that need to be followed, says Donise Mosebach, RN, MS, CEN, field director, Division of Accreditation and Certification Operations. "The purpose of SII was to clarify the standards, to delete any redundancies and make language easier for the field to interpret," Mosebach explains. "Within SII, there are no new standards included, and the survey process do not change — just the language of the standards."
In other words, the intent and requirements of the standards have not changed, she says. Organizations need to evaluate patient flow concerns from a systems perspective, in addition to the unique processes within an individual patient care unit, department, or service line, Mosebach says. "This is incorporated into our survey process and will be evaluated while conducting the on-site accreditation survey," she says.
Welcome news
This news should be welcomed by ED managers, says Michael Carius, MD, FACEP, chairman of the Department of Emergency Medicine at Norwalk (CT) Hospital and past president of the American College of Emergency Physicians. "I don't know how widespread the knowledge of the changes is in the ED community," he says. "This will actually help to dispel some of the concerns people might have about The Joint Commission and the direction they are going in."
Mosebach, who was an ED manager before joining The Joint Commission, adds, "The biggest part of SII is that it should make the intent and purpose behind the standards clearer for ED managers and help them understand what the expectation is."
Carius agrees the language has been simplified. "The thing that strikes me when I compare [the old and new] standards is that the 2009 revisions seem to be less wordy, a little easier to understand, and a little less proscriptive," he says.
However, Carius isn't sure that's always a good thing. For example, he is concerned about the simpler language in the standard that covers boarding. Here are the old and new standards:
• 2008 Standard: LD.3.15 EP 2. Planning encompasses the delivery of appropriate and adequate care to admitted patients who must be held in temporary bed locations, for example, post-anesthesia care unit and emergency department areas.
• 2009 Standard: LD.04.03.11 EP 2. The hospital plans for the care of admitted patients who are in temporary bed locations, such as the post-anesthesia care unit or the emergency department.
"Whether this is good or bad for EDs will really be subject to how it's interpreted," says Carius. "If hospitals feel the heat is off and they can do pretty much what they want, it will be bad for EDs."
What Carius means is that in the past administrators at some hospitals have "paid lip service" to the fact that boarding is a systemwide or hospitalwide problem, but they still consider it as an ED problem. "In many respects ED's have looked to The Joint Commission to help us convince administrators that boarding is a systems problem," he notes. "Whether this will make a difference in the right direction is not clear, because the language seems be a little more benign in terms of direction."
Two EPs may be better than one As The Joint Commission's Standards Improvement Initiative has unfolded, most of the changes have involved simplifying the language of the individual standards. However, in some cases a single element of performance (EP) has been split into two EPs to improve clarity. Here's an example involving assessment and reassessment: • 2008 Standard: — PC.2.20 EP1. The organization's written definition of the data and information gathered during assessment and reassessment includes the following: the scope of assessment and reassessment activities; the content of the assessment and reassessment; and the criteria for when an additional or more in-depth assessment is done. For example, nutritional or functional risk assessments may be defined for at-risk patients. In such cases, nutritional risk criteria should be developed by dietitians or other qualified individuals, and functional risk criteria should be developed by rehabilitation specialists or other qualified individuals. • 2009 Standard: — PC.01.02.01 EP 1. The hospital defines, in writing, the scope and content of screening, assessment, and reassessment information it collects. (See also RC.02.01.01, EP 2.) Note: In defining the scope and content of the information it collects, the organization may want to consider information that it can obtain, with the patient's consent, from the patient's family and the patient's other care providers, as well as information conveyed on any medical jewelry. — PC.01.02.01 EP 2. The hospital defines, in writing, criteria that identify when additional, specialized, or more in-depth assessments are performed. (See also PC.01.02.07, EP 1; PC.01.02.03 EPs 7 and 8.) Note: Examples of criteria could include those that identify when a nutritional, functional, or pain assessment should be performed for patients who are at risk. "This reworking of the standard is good," says Michael Carius, MD, FACEP, chairman of the Department of Emergency Medicine at Norwalk (CT) Hospital and past president of the American College of Emergency Physicians. "It takes excess verbiage out, but still says you have to redefine the scope and planning of assessment and reassessment." Making two EPs out of one "simply works better," Carius adds. "This may be seen as beneficial for ED managers." |
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