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Concept: Trent Accreditation Scheme


OBJECTIVE: /st>The aim of the study was to determine accreditation surveyors' and hospitals' use and perceived usefulness of clinical indicator reports and the potential to establish the control relationship between the accreditation and reporting systems. The control relationship refers to instructional directives, arising from appropriately designed methods and efforts towards using clinical indicators, which provide a directed moderating, balancing and best outcome for the connected systems. DESIGN: /st>Web-based questionnaire survey. SETTING: /st>Australian Council on Healthcare Standards' (ACHS) accreditation and clinical indicator programmes. RESULTS: /st>Seventy-three of 306 surveyors responded. Half used the reports always/most of the time. Five key messages were revealed: (i) report use was related to availability before on-site investigation; (ii) report use was associated with the use of non-ACHS reports; (iii) a clinical indicator set’s perceived usefulness was associated with its reporting volume across hospitals; (iv) simpler measures and visual summaries in reports were rated the most useful; (v) reports were deemed to be suitable for the quality and safety objectives of the key groups of interested parties (hospitals' senior executive and management officers, clinicians, quality managers and surveyors). CONCLUSIONS: /st>Implementing the control relationship between the reporting and accreditation systems is a promising expectation. Redesigning processes to ensure reports are available in pre-survey packages and refined education of surveyors and hospitals on how to better utilize the reports will support the relationship. Additional studies on the systems' theory-based model of the accreditation and reporting system are warranted to establish the control relationship, building integrated system-wide relationships with sustainable and improved outcomes.

Concepts: Game theory, Better, Report, Management, Utility, Trent Accreditation Scheme


In the United States, hospitals receive accreditation through unannounced on-site inspections (ie, surveys) by The Joint Commission (TJC), which are high-pressure periods to demonstrate compliance with best practices. No research has addressed whether the potential changes in behavior and heightened vigilance during a TJC survey are associated with changes in patient outcomes.

Concepts: Patient, Hospital, United States, Quality assurance, Hospital accreditation, Accreditation, Joint Commission, Trent Accreditation Scheme


This article describes the processes and tools used by WellStar Paulding Hospital to plan and design a new intensive care unit (ICU) as part of a 108-bed replacement hospital on a new site. Seeking to create a culture of safety centered around patient care, quality, and efficiency, the team used multiple external resources to increase their effectiveness as participants in the design process and to ensure that the new ICU achieves the functional performance goals identified at the beginning of planning and design. Specific focus on evidence-based design was assisted through participation in the Center for Health Design’s Pebble Project process as well as the Joint Commission International Safe Health Design Learning Academy Pilot Program.

Concepts: Health care, Patient, Hospital, Design, Healthcare quality, Hospital accreditation, Joint Commission, Trent Accreditation Scheme


Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility.

Concepts: Health care, Clinical trial, Patient, Hospital, Physician, Pharmaceutical industry, Clinical research, Trent Accreditation Scheme


In an effort to decrease antimicrobial resistance and inappropriate antibiotic use, The Joint Commission (TJC) recently issued new antimicrobial stewardship standards, consisting of 8 elements of performance, applicable to hospitals effective January 1, 2017. These standards coincide with those recommended by the Infectious Diseases Society of America (IDSA) and the Society of Healthcare Epidemiology (SHEA) guidelines. Little guidance exists on the “how” from these guidance documents. We review the 8 standards and provide real-world experience from established antimicrobial stewardship programs (ASPs) on how institutions can comply with these guidelines to reduce inappropriate antibiotic usage, decrease antimicrobial resistance, and optimize patient outcomes. TJC antimicrobial stewardship standards demonstrate actions being taken at the national level to make quality and patient safety a priority.

Concepts: Epidemiology, Infectious disease, Hospital, Infection, Hospital accreditation, Joint Commission, Trent Accreditation Scheme, International healthcare accreditation


Antibiotic stewardship programs (ASPs) improve antibiotic prescribing. 73% of United States (US) hospitals have < 200 beds. Small hospitals (< 200 beds) have similar rates of antibiotic prescribing compared to large hospitals but the majority of small hospitals lack ASPs that satisfy the Centers for Disease Control and Prevention's (CDC) core elements. All hospitals, regardless of size, are now required to have ASPs by The Joint Commission and the Centers for Medicare and Medicaid Services has proposed a similar requirement. Very few studies have described the successful implementation of ASPs in small hospitals. We describe barriers commonly encountered in small hospitals when constructing an antibiotic stewardship team, obtaining appropriate metrics of antibiotic prescribing, implementing antibiotic stewardship interventions, obtaining financial resources, and utilizing the microbiology laboratory. We propose potential solutions that tailor stewardship activities to the needs of the facility and the resources typically available.

Concepts: Medicare, Hospital, Centers for Medicare and Medicaid Services, Medicaid, Hospital accreditation, Medicare and Medicaid, Joint Commission, Trent Accreditation Scheme


A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization.

Concepts: Medicine, Epidemiology, Bacteria, Medical statistics, Antibiotic resistance, Allergy, Penicillin, Trent Accreditation Scheme


To (1) evaluate rates of surgery for clinical stage I-II pancreatic ductal adenocarcinoma (PDAC), (2) identify predictors of not undergoing surgery, (3) quantify the degree to which patient- and hospital-level factors explain differences in hospital surgery rates, and (4) evaluate the association between adjusted hospital-specific surgery rates and overall survival (OS) of patients treated at different hospitals.

Concepts: Patient, Hospital, Surgery, Physician, Islamic Golden Age, The Association, Al-Andalus, Trent Accreditation Scheme


Background: The Joint Commission has mandated universal screening and assessment of hospitalized patients for malnutrition since 1995. Although various validated and nonvalidated tools are available, implementation of this mandate has not been well characterized. We report results of a survey of hospital-based professionals in the United States describing their perspective on the current range of nutrition screening and assessment practices as well as associated gaps in knowledge. Methods and Materials: Data from a 2012-2013 cross-sectional, web-based survey targeting members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), the Academy of Medical-Surgical Nurses, and the Society of Hospital Medicine were collected with non-hospital-based members excluded. Descriptive statistical analysis was performed. Results: Survey data from 1777 unique email addresses are included in this report. A majority of respondents were dietitians, nearly half were A.S.P.E.N. members, and 69.4% reported caring for a mix of adult and pediatric patients. Most respondents answered affirmatively about nutrition screening being performed in alignment with The Joint Commission mandate, but only 50% were familiar with the 2012 Consensus Statement from the Academy of Nutrition and Dietetics/A.S.P.E.N. on adult malnutrition. In most cases, nurses were primarily responsible for nutrition screening, while dietitians had primary responsibility for assessment. No one specific assessment tool or International Classification of Diseases, Ninth Revision code was identified as being used a majority of the time in assessing or coding a patient for malnutrition. Conclusions: The survey findings affirmed compliance with accreditation standards in completing a nutrition screen within 24 hours of admission, and most hospitals appear to have a process to perform a nutrition assessment once a screen is completed. However, there is considerable heterogeneity in both use of tools and mechanisms for coding capture. Opportunities exist to improve education around nutrition screening and assessment and to identify ideal practices for these processes in hospitalized patients.

Concepts: Medicine, Nutrition, Hospital, United States, Hospital accreditation, Accreditation, Joint Commission, Trent Accreditation Scheme