Tuesday, September 23, 2008

How JCAHO hurts patient care.

My hospital recently had a JCAHO visit.  I realize that they could, with one sweep of the hand, ensure that my hospital would never receive another Medicare dollar, and thusly shut the place down.  But I have always found it difficult to give a rat's ass when these trolls are around.  I honestly don't care.  And maybe I should.  But I don't.

But I did make some observations about what happens in a hospital when JCAHO arrives.  The Joint Commission Pixie Dust is pumped through the ventilation system, and causes the following:

1. Administrators are actually in the hospital longer than most of the physicians.  A truly amazing effect.

2. Nurses spend even less time at the patient bedside, making sure all of their computer documentation is perfect.

3. The housekeepers shove chairs off to the sides of the hallway with ninja-like speed to ensure that "8 feet" of open corridor is free at all times.

4. CT scans take an hour longer since stretchers cannot be kept outside the patient room, waiting for the CT tech to finish his bon-b0ns and call the patient down.

5. The staff bathrooms are wallpapered with countless ridiculous "acronyms" (in all shades of neon), as if it's going to make nurses remember to go through the 8 steps of "TEAMWORK" when wiping a patient's ass, and 4 steps of "CALM" when soothing a patient threatening you bodily harm.

6.  The unit clerks turn all the patient charts face-down with obsessive-compulsion so that we feel better about patient "privacy".  (Nevermind the dry-erase board with all the patient names on it within plain view.  Or the to-be-taken-0ff order rack where a sheet of paper is sticking out of the chart and their name is visible.)  This adds an extra 5 minutes to my day looking for the damn chart.

7. My morning coffee is thrown away as a "rogue beverage" before I've even seen 2 patients each morning.

8. Everyone loses the ability to think critically, and literally loses their fucking mind.

I really wish we could quantitate the resource expenditure.  Individuals pulled from their usual jobs to perform "emergency" functions.  All the phone calls to doctors and nurses, pulling them away from patients (and, incidentally, billable activities) to make sure the DVT prophylaxis form is filled out for the patient with no legs.  How much do we SPEND to get the insulting Medicare breadcrumbs?

It just makes me realize how desperately hospitals need to learn some way... any way to function without the pittance of the government handout.  Because the care of our patient suffers every time we try to appease a bureaucrat.  Let us not even venture into how a private organization like JCAHO got such a blessedly profitable mandate to fall into their lap.

Our government doesn't realize that every time they try to fix something with a mandate, they fuck something else up.  And make healthcare more expensive, less efficient, and more dangerous for us all.

Tuesday, September 16, 2008