Cut Us Some Slack, JCAHO!

The Joint Commission (aka JCAHO, universally pronounced “Jayco” and thusly spelled in this post) is a group of fuddy-duddies who, since they apparently can’t get real jobs in health care, go around inspecting hospitals and making up increasingly onerous and byzantine rules in order to punish legitimate health care workers.  For years this rogue agency (which is a private sector organization) has terrorized hospital administrators, nurses, and doctors, coming up with more and more ridiculous mandates that only serve to make health care more costly and unwieldy.  When they show up at your hospital, you start to hear the nervous whispers in the background: “Jayco is here.  Watch out.”  I remember at my former institution our EP nurses taped the red sharps bucket to the wall (with scotch tape!) because some Jayco rule prohibited that sharps buckets could be sitting on a counter top.  Break one rule and your hospital could be shut down to become a empty ruin, much like an abandoned TB sanitorium — or so one would think based on how hospitals react to a surprise Jayco visit.

The rule that bugs me the most states that before doing a procedure there must be a “current” History and Physical (H&P) in the chart.  Current means done within 30 days.  If the office note is more than 30 days old, the physician must write out a new H&P before the procedure can be done.  Why this H&P is necessary is not explained.  Why a 30 day old H&P is ok but a 31 day old H&P is no good is not clear either.  If a doctor at hospital A has a procedure at hospital B with an out of date H&P, he must leave hospital A 30 minutes earlier than he would otherwise in order to do the H&P, and then wait at hospital B for the patient to be put on the table and prepped, potentially without any other work at hospital B; i.e. wasting his/her time.  Not very efficient!  In the case of my practice, the office notes  from our EMR system are extremely detailed and well-formatted.  If this office note is out of date, my hastily scribbled note, lacking all details, becomes the official H&P note — basically a useless note, but meeting the time window mandated by Jayco.  This rule affects my life nearly every day, slowing me down, and adding nothing to patient care.  By the way, even though this updated H&P is compulsory, you can not bill for the H&P.  It is considered a part of the procedure.  Great!

In a busy practice it is very difficult to get an elective procedure scheduled within 30 days of an office visit.  I am realistic enough to know that Jayco won’t go away any time soon.  I would like them to lighten up on this one rule.  Extend the definition of a current H&P to 60 days, and probably 90% of these H&P updates would become unnecessary.  This would tremendously speed up my day, get patients their procedures on time, and overall improve efficiency.  Seems like a good compromise to me.


By mannd

I am a retired cardiac electrophysiologist who has worked both in private practice in Louisville, Kentucky and as a Professor of Medicine at the University of Colorado in Denver. I am interested not only in medicine, but also in computer programming, music, science fiction, fantasy, 30s pulp literature, and a whole lot more.


  1. I could not agree with you more. Believe me the Cath Lab staff having to call the MD’s as much as you hate getting the call to come sign a ridiculoues little sticker that says nothing but the fact you signed you name and said you were there. I agree that it is the biggest waste of your time and our time waiting for you to get there it only delayes procedure and causes unnecessary conflict between staff and MD’s with threats of being bumped if you don’t get there in tim. There are so many other things that need to be addressed in the hospital than a useless piece of sticker with your autograph. The fact that the fifth floor has 60 beds not in use when we are holding patients in the ER and anywhere we can because we don’t have enough beds, seems that JAYCO is more worried about a linen hamper that is open,a boc with a shipping label,someone coffee mug sitting out and stupid petty stuff that don’t amount to nothing than the big things at hand like wait times,not enough staff to properly care for patients as they should be and I could go on and on but I wont the bottom line is you are so right!

  2. I believe that most people who have to work with these regulations would agree with you. It is as though the people in charge of making these rules have not actually worked in a hospital or been apart of a physicians group. They present themselves as patient advocates then create mounds of paperwork and meetings that do not instigate patient care. (Your blog reminds me of Dr. Mandrola’s blog on who should write the medical guidelines.) I too would like to see these agencies rework some of their requirements to facilitate care and wellness in an efficient manner.

  3. I’ve been a RN for 13 years. I have watched hospitals’ focus change from providing patient-centered care to JCAHO and CMS focused care. It has been a sad transition. More time and attention is devoted to leaving the appropriate paper trail and jumping through hoops than is devoted to providing high quality patient care. JCAHO has worked its way into power as the appointed ‘watch dog for patient safety.’ Newsflash: JCAHO is watching the hospital, the hospital is watching the health care providers, health care providers are busy trying to fill out forms in triplicate and comply with this weeks decree…NO ONE is watching the patient!!!!

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