JCAHO May Threaten Patient Safety

Martin Bogetz, M.D.

To the Editor:

Recent institutional policies devised to address (perceived) accreditation standards may actually lead to disaster. Two issues were a major focus during our recent accreditation survey. In California, many hospitals have removed patients’ names from operating room scheduling boards. In the name of patient confidentiality, the full name has been replaced by first name only, initials, social security number or another scheme. Many anesthesiologists, nurses and surgeons believe this is both unnecessary and potentially catastrophic.

Of greater concern are policies that demand anesthesia carts and supplies be locked in areas such as obstetrics where immediate access to equipment and agents is an unquestioned absolute need. Within the secure confines of the operating room, non-controlled medications must be secured and out-of-view because of the concern that unlicensed personnel such as scrub technicians, anesthesia workroom, and custodial staff represent a tampering risk. Securing agents at the end of each case distracts attention from the patient and hinders immediate access in the rare but critical instances when they are needed. Most importantly, anesthesiologists should take the lead in speaking out against the adverse profiling (suggested by the negative assumptions and suspicions) of these full-time and dedicated employees with whom we work.

Accreditation organizations, such as the JCAHO, state that their standards do not require these draconian policies. Their consultants and surveyors demand otherwise. I call on the APSF to take the lead in determining whether such policies are indeed dangerous.

Martin Bogetz, M.D.
Medical Director, UCSF Surgery Center
Professor of Clinical Anesthesia
University of California, San Francisco