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In 1905, Ernest Codman, MD, first described the “end result idea.” In 1913 the American College of Surgeons (ACS) was founded to improve the quality of care of surgical patients by establishing standards for surgical education and practice. These early efforts gave birth to a hospital standardization program, but the results of the 1918 field trials were so shocking they were suppressed and destroyed. In 1917 only 89 of 692 met these standards. By 1950, 3200 hospitals met the standards of care. In 1951 unresolved quality concerns sparked a formal relationship between four healthcare organizations. ACS, AMA, AHA, and the American College of Physicians collaborated to form the Joint Commission on Accreditation of Hospitals, now known as the Joint Commission on Accreditation of Healthcare Organizations. In 1965, Congress passed the Social Security Act enacting Medicare. This legislation also contained a provision that if a hospital had earned JCAH accreditation that the hospital was “deemed” to be in compliance with most of the Medicare conditions to participate. Accreditation is an internationally recognized process through which healthcare organizations are able to improve the safety and quality of services delivered to patients. The focus of accreditation is to help organizations understand what they are doing well and what opportunities are available for improvement. Joint Commission standards address the organization’s level of performance in key functional areas. › patient rights › patient treatment › medication safety › infection control The standards focus on setting expectations for an organization’s actual performance and for assessing its ability In addition to accreditation, JCAHO certifies programs. Certification is earned by programs or services that may be based within or associated with a healthcare organization. A JCAHO accredited medical center can have certified programs or services The JCAHO is governed by a 29-member Board of Commissioners that includes physicians, administrators, nurses, employers, a labor representative, health plan leaders, quality experts, ethicists, a consumer advocate, and educators. The present accreditation programs offered by JCAHO include ambulatory care, behavioral health care, critical access hospitals, home care, hospitals, laboratory services, long term care and office-based surgery. Every type of organization accredited by JCAHO has a manual that is customized to fit the scope of services offered by the The manuals for hospitals are quite large and contain the following areas: › › › › › › › › › › › › › › Emergency Management Environment of Care Human Resources Infection Prevention and Control Information Management Leadership Life Safety Medical Staff Medication Management National Patient Safety Goals Performance Improvement Provision of Care, Treatment, and Services Record of Care, Treatment, and Services Rights and Responsibilities of the Individual A JCAHO survey is tailored to the facility and consists of › Care delivered to patients › Verbal and written documentation provided to JCAHO › On-site interviews and observation These site visits occur every 18 to 39 months, can be unannounced, and include a team of surveyors who spend about a week learning the specific JCAHO does not issue monetary fines. A non-compliant review by JCAHO may lead to non-accreditation. JCAHO may perform "unannounced" inspections but not always. JCAHO requires written follow-up reports. JCAHO requires written policies and procedures. JCAHO covers patients, visitors, and staff safety. JCAHO uses performance oriented criteria In response to patient safety concerns, JCAHO introduced National Patient Safety Goals. This is a part of the evaluation process. The patient safety goals for hospitals include › improve the accuracy of patient identification › improve the effectiveness of communication among caregivers › improve the safety of using medications In 1999, patient safety became a major area of focus. The Institute of Medicine released a report stating that between 44,000 and 98,000 people die each year from medical errors. Rather than individual error, the report said the problem is caused by faulty systems and processes, and other conditions that lead people to make FDA – Food and Drug Administration – drug approvals, drug safety information, and providing information about medication errors. AHA – American Hospital Association – voice of hospitals and health systems in Washington. AMA – American Medical Association – Every state has a law that describes how medicine will be practiced within the state. This Act usually establishes the medical board for the state and protects the health and safety of the public. This board establishes the licensure standards, credentials, and sanction How does law relate to medicine? Tort law- (intentional) a patient can sue a physician for medical or physical injury caused by the physician or the physician’s employee Battery (unlawful touching)- no procedure can be performed without a patient’s consent: offering an arm to a phlebotomist to allow a blood draw is implied consent. HIPAA – Health Insurance Portability and Accountability Act; this is an example of legislation passed by congress. Improves the portability of health insurance, combats fraud, abuse, and waste in healthcare, promotes the expanded use of medical savings accounts, and simplifies the administration of health care insurance. JCAHO’s philosophy concerning patient safety is that No adverse event should ever occur anywhere in the world if the knowledge exists to prevent it from happening. Patient safety solutions are defined as “any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from JCAHO is not a body that enforces regulatations; however, they promote safety and quality patient care through the accreditation process. JCAHO exists to improve standards of care. Through programs and surveys, medical standards of care are constantly improving.