When Compliance Affects Quality

One hospital is definitely meeting one defined performance standard set by Joint Commission and Centers for Medicare and Medicaid Services which should be good news.  Hospital quality performance standards are generally set to reduce mortality.  In this particular case, caution is needed in interpreting this performance standard.  This particular performance standard requires that patients with pneumonia receive antibiotic treatment within 4 hours of arriving to the hospital.  This sounds like a good thing, but apparently it has been found that for this one particular hospital, the focus on time and delivering the medication has contributed to misdiagnosis 39% of the time... which would also mean unneccessarily prescribed antibiotic treatment and time wasted due to diagnostic error. 

The above compliance issue doesn't pertain to physical therapists.  I do wonder though...  Joint Commission did require daily treatment documentation on pain intensity.  Not documenting pain level was in direct non-compliance.  I never followed this documentation requirement unless I clinically needed that information.  For patients with chronic pain or fear, it isn't in the best interest of the patient to focus on pain intensity.  Common sense should prevail; obviously one of the reasons the patient was receiving physical therapy services was because of pain.  Our observational and manual skills should be able to guide our clinical decision-making especially when we have a patient that requires a cognitive behavioral component to improve outcomes.

Are there any other compliance issues that could potentially affect the quality of our services?

Selena

Comments

[Skibjork]

I work for ARUP Laboratories in Salt Lake City and I see unnecessary laboratory testing happening frequently because of compliance or "protocol."
ARUP created ARUP Consult with the help of University of Utah medical faculty to give physicians at the point of care access to more than 1,600 lab tests, test suggestions, interpretations, nearly 50 algorithms and concise diagnostic advice. It's created as a supplement to physicians so they receive the most current lab information/options for optimum patient care. If more physicians could follow this instead of "protocol," which is another argument in itself, I'm sure there would be much less mis-diagnosis and quicker patient TAT.