NJ hospital group, others advise caution
Coming up with a safe way to satisfy JCAHO
The New Jersey Hospital Association (NJHA) has made recommendations to the Joint Commission about how the agency might review reported sentinel events without putting hospitals at risk of disclosing confidential or otherwise privileged information.
Some of the recommended approaches include using aggregate data rather than data on specific events, and looking at other discoverable information about the event, such as the systems and processes that have been put in place to address sentinel events.
The Princeton-based NJHA, which represents 115 of the state's hospitals and health systems, has advised its members against voluntarily reporting sentinel events to the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, and continues to engage the agency in discussions about how best to proceed in its state.
Disclosure often indicates waiver of privilege
Hospital Peer Review attended a Joint Commission sentinel event seminar in New Jersey. That state's hospitals - as well as hospitals in many other regions - are concerned about maintaining protection under existing peer review privilege if they disclose information to the Joint Commission. In most jurisdictions, the privilege is upheld only if the results of any internal investigation remain confidential, says Elizabeth Van Hoeven, legal counsel for NJHA. Once a hospital discloses information, many courts, including New Jersey's, would view this as a waiver of privilege.
If you and your staff already have attended one of the Joint Commission's full-day education programs on sentinel events, you know they have instigated some serious thinking and discussions on issues surrounding the revised policy. The presentations have been taking place all around the country since March, and will continue through November. [For further information on the Joint Commission's seminars on sentinel events, call (630) 792-5800.]
Many hospital associations have responded to the continually evolving policy by instituting task forces to deal with sentinel event issues. Quality professionals are concerned about relinquishing their rights to confidentiality when they provide information in their root-cause analyses. Your challenge now is to come up with an approach that will satisfy the Joint Commission while protecting sensitive information from discovery - information that often contains evidence that could be used in a lawsuit.
A survey of states indicates that, despite state statutes that may protect documents from discovery, there are challenges - and there is much uncertainty about the future. "The majority of states have those issues to deal with," says Jan Ronzio, RN, risk manager at Exempla St. Joseph Hospital in Denver. (See sentinel event process flow chart, p. 159, and the eights steps of her root-cause analysis process, above.) Some quality managers in those states report that if an incident has not been settled and a release has not been signed by the plaintiff, they take the risk of piercing the veil of confidentiality by releasing the information to a third party that is not protected by statute.
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