Enforcing one-hour rule generates controversy

The Health Care Financing Administration’s "one-hour rule," which requires physicians to do a face-to-face evaluation of a restrained patient within one hour, is now being enforced by the Joint Commission, reports Ann Kobs, president and CEO of Type 1 Solutions, a Fort Myers, FL-based compliance consulting firm specializing in preparation for Joint Commission surveys.

Not all EDs have a physician immediately available to write the order and perform a face-to-face evaluation, Kobs says. "Over 50% of the hospitals in this country have under 100 beds," she notes. "Many of those EDs don’t have a physician in-house 24 hours a day."

The one-hour rule for behavioral health has created a lot of controversy in hospitals, Kobs reports. "This creates a culture war, because administration has to make the move to come into compliance," she says. "That means rousting physicians out of their offices or bed to come see a patient for a face-to-face assessment within one hour of applying [with a phone order] restraints."

You might bear the brunt of enforcing this new standard, warns Kobs. "Nurses will probably be stuck with the frustrating task of trying to get those doctors into the ED, and take all kinds of abuse in the process."

Administrators need to take the heat for enforcing this standard, says Kobs. "It’s about putting teeth into the policy," she says. "This takes a gutsy CEO and chief of medical staff who enforces getting those folks in there. If they all wimp out, nurses will be caught in the middle."

The hospital CEO doesn’t want any physician to leave or upset the board, she notes. "The chief of staff has to herd the physicians into doing something they don’t want to do," she says. "This is not nursing’s issue, so the best thing nurses can do is not own it. Just keep passing this to medicine and administration."