Hospital fails to better marginal accreditation

Shady Grove continues under conditional approval

March 17, 2000|By M. William Salganik | M. William Salganik,SUN STAFF

The national organization that accredits hospitals decided yesterday that it will keep Shady Grove Adventist Hospital on conditional accreditation status -- the only Maryland hospital so designated -- extending a period of unusually strict scrutiny for the Rockville facility.

The attention began in October, when Shady Grove's medical staff said it was worried about quality, setting off a series of inspections and downgradings by state and federal regulators and by the private Joint Commission on the Accreditation of Health- care Organizations (JCAHO).

Yesterday, JCAHO said it will review the hospital again in an unannounced survey within six months. Normally, the commission visits hospitals on a three-year cycle.

"We view this as a very positive decision," said Terry White, Shady Grove's president and chief operating officer, in a written statement. "The joint commission indicated to us today that we are making progress and heading in the right direction. -- What they will be looking for in the next six months is to ensure we can sustain the level of improvement we have started."

The hospital also expects word soon from a re-inspection by the state health department. State officials concluded in November that "the frequency and nature of the deficiencies suggested a possible serious and immediate threat to the health and safety of the patients." That state report documented 15 cases of patient falls, medication errors and other problems, including:

A 79-year-old woman in intensive care, left unattended in a hallway outside the radiology department in October, suffered cardiac arrest. When hospital staff attempted to resuscitate her, some equipment didn't work. This was the only case covered in the state report in which a patient died.

An 81-year-old woman with a broken right hip received surgery on her left hip in December 1998. The next day, she complained of right hip pain, but the error was not discovered until an X-ray three days later.

A 33-year-old man with a known penicillin allergy was given a penicillin derivative intended for his roommate in August.

JCAHO's reports focus not on cases but on procedures, so they are not as dramatic as the state's findings. JCAHO made a one-day visit to Shady Grove in October and criticized communications, medical records, coordination and other areas of Shady Grove's operation.

It demoted the hospital from its highest rating, "accreditation with commendation," granted in 1998, to its lowest level of approval, "preliminary non-accreditation." Less than 1 percent of U.S. hospitals are placed in this lowest rung. After an appeal by Shady Grove, JCAHO upgraded the hospital last month to conditional accreditation -- a level also applying to about 1 percent of the hospitals in the country.

Located in the affluent and fast-growing Interstate 270 corridor, surrounded by gene splicers and other high-tech businesses, Shady Grove seems in some ways an unlikely hospital to have such problems. Because the area is growing, the 20-year-old hospital's occupancy rate is high, and most of its patients are insured.

But all hospitals feel financial pressures, and Shady Grove took actions over the past few years to keep costs down. According to materials filed with JCAHO, Shady Grove eliminated 27 positions, including five nursing positions, and reduced hours for 14 others during 1999. (The hospital has 1,725 employees, of which 1,135 are "clinical employees with patient contact," according to the filing.)

In 1998, the institution did a "re-engineering," changing from a staff of registered nurses to a mix of nurses and "patient care technicians," who perform such functions as bathing and transporting patients, said Robert Jepson, a spokesman for the hospital's parent, Adventist HealthCare. The number of registered nurses was reduced by attrition, Jepson said.

During this time, it seemed a number of experienced nurses left and were replaced by those with less experience, causing concerns among doctors, according to Dr. Ruth Jacobs, an infectious disease specialist.

Doctors complained, "but it wasn't clear they really took us seriously," said Dr. Alan Kravitz, a surgeon who practices at the hospital. Eventually, he said, concerns voiced by the medical staff's executive committee were reported in the Washington-area news media. The state and JCAHO re-evaluations quickly followed.

Since then, the hospital has gotten new top executives, replacing those it once shared with Washington Adventist Hospital in Takoma Park.

The hospital also created a task force on the administration of medication and created councils to monitor standards of care and nursing quality, Jepson said. Shady Grove has not added staff. Reviews showed its staffing level equal or better than similar hospitals, he said.

"The scrutiny has been unrelenting and has buffeted the hospital to an extent few hospitals in the state have seen," Jepson said. "At the end of the day, we will come out a stronger institution."

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