Here’s what JCAHO asked on ethics, care continuum
Differing religious views addressed
In the ongoing saga of triennial Joint Commission on Accreditation of Healthcare Organizations visits, the concerns of providers are, "What are they going to ask?" and "Will we have the answers?"
With that in mind, Edward Emnett, RN, CPHQ, shared with Hospital Access Management his firsthand report of Joint Commission interviews and the access department’s involvement in the survey. Specifically, the surveyor was interested in ethics and continuum of care issues at St. Joseph’s Medical Center in Tampa, FL. Emnett is manager of clinical resource management at South Florida Baptist Hospital in Plant City, a sister hospital of St. Joseph’s. Both are part of the 10-hospital Baycare Health System.
It’s a good idea for access managers to make sure their employees are aware of the organization’s ethics committee and of the issues that might be appropriate to address in that forum, he suggests. Access staff also should be ready to answer inquiries about policies having to do with the continuum of care at their facility.
The surveyor asked about how the organization identified information about a patient’s pre-hospital status, he says. The hospital representatives informed the surveyors that case managers have an assessment tool that provides that information. Another question, he adds, was, "What programs are in place to address domestic violence, for identification and triage?"
During the May Joint Commission survey at St. Joseph’s, Emnett says, the hospital’s ethics committee — with representatives from pastoral care, social work, nursing, dietary services, legal services, and administration, as well as two physicians — fielded these questions, among others:
• Do you think you are an effective or an ineffective committee?
• What are some of the issues the committee has addressed?
• What is your role in the mission of the organization?
• What kind of education do you provide?
• How is organ donation handled?
"One big issue was what do we do for education, not only of the team in the hospital, but for those on the ethics committee," Emnett says. "These were questions I didn’t know the answer to and was concerned about."
The St. Joseph’s committee, he adds, explained that at least a couple of members are sent each year to a state conference on bioethics. New members are given a membership packet that includes current readings on bioethics and case studies, he says. "There is a wealth of information they have put together. Before doing a case consultation, [new members] are mentored by those who are experienced."
Committee members also described "grand rounds," open to all staff, which include presentations on ethical issues, followed by panel discussions. Community outreach programs dealing with similar issues are in the planning stages.
Regarding organ donation, the surveyor asked how the process works and how the family is approached. Committee members explained that such cases are referred to a local group called Lifelink, which handles the process.
Emnett was most surprised, he says, by a question having to do with the different religious orientations of the four Baycare hospitals that make up the community alliance known as St. Joseph’s Baptist. The surveyor wanted to know if religious beliefs affected the decision to provide certain types of care. "[The surveyor] asked if issues came up concerning the two religious philosophies — Baptist and Catholic — and if so, how were they managed? What mechanisms were in place to handle that?"
Committee members explained there is a council within the larger Baycare system that resolved such issues before a joint operating agreement was signed by the various hospitals. "The hospitals that were providing [some women’s health] services before are still providing them," he adds.
The segment of the survey having to do with continuum of care was "low-key, not as aggressive as usual," Emnett points out. "It was a short interview. The surveyor had been very impressed with what he saw in the hospital."
There was one interesting question that no one could answer, he notes: "How can hospitals impact agencies in the community, such as the Division of Families and Children or nursing homes, to improve the level of care patients will receive after they leave the hospital?"
Finally, Emnett says, the surveyor asked about the greatest challenges to providing a continuum of care for patients. Those include placing ventilator patients, difficulty with prospective payment system reimbursement, and placing critically ill patients who are flown in from other counties.
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