Fewer Hospital Deaths Occur When Inspectors Present: Study

The findings of a new study indicate that U.S. hospitals that were monitored by surprise inspections had lower death rates, compared to weeks when the facility had no inspections. 

Researchers from Harvard conducted an observational analysis of 1,984 unannounced hospital surveys by The Joint Commission, indicating that when surprise inspections occurred, death rates at the hospitals improved.

The study was published this week in the medical journal JAMA Internal Medicine, evaluating data on Medicare admissions from 2008 to 2012, representing nearly 70% of all Medicare admissions during that time period.

The survey involved nearly 245,000 admissions during the survey week and 1.4 million admissions during non-survey weeks. The average number of weekly admissions was similar between survey and non-survey weeks. Patient characteristics were also very similar.

Hospitals in the United States are accredited by The Joint Commission, which conducts surprise inspections at hospitals across the country. This may include supervising patient visits, monitoring surgeries and being present during other interactions. Weeks involving surprise inspections can cause high pressure periods for healthcare professionals to demonstrate compliance with established rules and best practices.

The survey focused on patient death rates three weeks before and three weeks after the surprise surveys, as well as during the week of the survey.

Overall, patients admitted during the week of the survey had significantly lower 30-day mortality rates than patients admitted in the three weeks before or after the survey.

The data indicated 30-day mortality rates for admissions during survey weeks was seven percent compared to 30-day mortality rates at 7.21% during non-survey weeks.

The change was more significant for surveys conducted at major teaching hospitals. At teaching hospitals the mortality rate decreased from 6.4% during non-survey weeks to 5.9% during survey weeks. Researchers said that equated to a 5.9% relative decrease in 30-day mortality rates.

The study also showed a decrease in mortality rates in patients in the top half of expected deaths. That rate decreased from 13.37% during non-survey weeks to 13.08% during survey weeks.

There were no significant differences in admission volume, length of stay, or secondary outcomes.

“Patients admitted to hospitals during TJC survey weeks have significantly lower mortality than during nonsurvey weeks, particularly in major teaching hospitals,” the researchers concluded. “These results suggest that changes in practice occurring during periods of surveyor observation may meaningfully affect patient mortality.”

With nearly 1 million annual Medicare hospital admissions, a reduction in death rates like those seen during the inspections would equate to nearly 4,000 fewer deaths each year.

Researchers said the findings indicate changes in medical practice, such as those seen during the survey weeks, may meaningfully affect patient mortality and should be adopted. Doctors may simply be more focused and alert when they are being monitored, meaning better outcomes for patients.