Definition/Introduction

The Joint Commission (TJC) is an independent, not-for-profit organization created in 1951 that accredits more than 20,000 US health care programs and organizations.[1] TJC's goal and mission are to ensure quality healthcare for patients, prevent harm, and improve patient advocacy. About 70 to 80% of TJC functions directly address the issue of patient safety. The Joint Commission's stated mission is: "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value." TJC has specific quality measures holding healthcare organizations accountable for health-related outcomes. TJC offers an unbiased assessment of the organizations' quality achievement in patient care and safety. It mainly accredits organizations in the US but also in many other countries around the globe. The certification by TJC provides organizations with a 'report card' format for ease of understanding in healthcare consumers.

Issues of Concern

TJC aims to avoid medical errors and non-compliance in healthcare organizations by evaluating other factors that could affect patient safety and care. Such factors include, but are not limited to, multi-tasking, interruptions, worker fatigue, communication issues, and more.[2][3] TJC visits hospitals between 18 to 36 months since their last hospital survey, and they select patients to complete the survey about their hospital stay. Both performance standards and outcome measures are traced through surveys by the TJC. Commonly, TJC announces their visit at the start of the week and appears at the organization on the day of the announcement. Hence, the visits are considered unannounced as healthcare organizations must continuously prepare for the visit. TJC certification is necessary for hospitals to obtain liability insurance, operated with support from the state and federal government in the form of Medicare and Medicaid payors. 

TJC has specific standards and quality measures for holding healthcare organizations accountable to protect the public for safety in a standardized format:

• Standards are based on the reported adverse events by organizations that may or may not cause harm to patients, such as medication errors, incorrect site in surgical procedures, and miscommunication among healthcare providers.
• Quality measures have their basis on health-related population-focused commonalities, such as congestive heart failure patients with frequent readmissions and pressure ulcers acquired by patients while being hospitalized.

Clinical Significance

TJC helps hospitals and healthcare facilities to gain reputation by awarding them accreditation. These health care organizations are reviewed every 2 to 3 years. If organizations are compliant with all the standards, they receive accreditation. Otherwise, organizations must develop plans of action to improve safety and quality to satisfy the TJC. If a facility would like to be accredited by TJC, they pay a fee to the agency. After they have received a passing grade, they can display the results to the public. There is a fee of about $46,000 per year to keep the accreditation. 

The accreditation is crucial to demonstrate compliance and commitment to patient safety. TJC adopts a tracer methodology to survey hospitals on compliance with safety.[4] The on-site survey process is to identify performance issues in the hospitals through individual tracer activity, system tracer activity, and accreditation program-specific tracers. 

• Individual: Tracing a patient's experiences while obtaining care at the hospital during the utilization of the facility's treatment and services through the course of care. For example, the tracing can start with a patient arriving in the emergency department and goes through the admitting process in registration, then has triage performed by nurses, receives a medical screening exam by a physician, physician assistant, or nurse practitioner, and subsequently goes through radiology, and laboratory services. 
• System: Involves tracing the experiences of a patient while obtaining care at the hospital with a focus on care coordination, communication, departmental processes, infection control practices, and medication management. For example, the tracing can start with a patient arriving for surgery, starting with registration in admitting office, insurance verification, preoperative services; obtaining radiology service, diagnostic department for electrocardiogram; going through the surgery department, recovery department with a discharge process or a transfer to an inpatient unit. 
• Program-specific: Evaluating a specific program's risk and safety concerns within an organization that provides a particular treatment or service and may be high-risk or high-volume patient populations. An example of this type of certification is a stroke program or a comprehensive cardiac care program.

Nursing, Allied Health, and Interprofessional Team Interventions

Preparing for TJC evaluations and surveys can be a difficult task for healthcare organizations and their workers. The organizations must be up to date with TJC standards, policies, processes, and procedures at all times due to the common practice by TJC of unannounced visits. For example, the Joint Commission has Quality Measures for Acute Myocardial Infection or Congestive Heart Failure. This resource is useful for healthcare providers to make sure they do not overlook any highly effective measures. These checklist items allow for organization and consistency to ensure that each hospital is doing what it must to improve standardization across the hospitals. 

Nursing, Allied Health, and Interprofessional Team Monitoring

The Joint Commission has seven foundations of safe and effective transitions of care to home for patients [5]:

• Leadership support: Support stakeholders' senior leaders to invest in finding solutions for reducing readmissions.

• Multidisciplinary collaboration: Collaborations among healthcare professionals in an interprofessional approach to achieve optimal outcomes and avoid readmission for cost reduction.

• Early identification of patients/clients at risk: Encourage healthcare providers to identify at-risk patients early and factors that may affect health outcomes such as health literacy and confidence in self-care with discharge education.

• Transitional planning: Coordination and plan of care must be continuous among providers, organizations, and suppliers to ensure patients having the necessary equipment and medications when departing the hospital.

• Medication management: Health literacy assessment and appropriate education on drugs and ensuring patients get the necessary physical medications at the time of discharge. Medications prescribed in prescription may not be necessarily available to patients due to insurance or backorders.

• Patient and family action/engagement: Family engagement is crucial in the patient's health. Recovering from illness necessitates the family's involvement in caring for the patient.

• Transfer of information: It is imperative to have a successful transfer of information to provide healthcare providers with crucial details for properly caring for discharged patients.