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Use this case study to prepare a mock tracer survey

Accreditation Connection, December 22, 2003

When surveyors arrived on-site at Kaiser Permanente in Sacramento, CA, they first asked for a complete list of all patients in the hospital. They also wanted a list of patients at the hospital's home health care and hospice care facilities.

Surveyors chose a total of 10 patients as tracers-two or three patients from each of the hospital's facilities. They followed each patient over a four-day period. Each tracer session-that is, the review of each tracer patient-took between two and three hours to complete.

The surveyor team included representatives from key areas of hospital care, including two nurses, two administrators, and three physicians.

Surveyors determined which types of patients they would choose
Tip: Consider asking staff to pull approximately 15 random patient charts and time them as they do so. This will help you identify any roadblocks that might prevent staff from locating charts-and it will also help staff to be less nervous-during the actual survey.

Selected tracer patients included one who received care in the emergency room, one who received care in the ICU, one who underwent a caesarian-section delivery, and one who received treatment at the hospital's eye center.

The hospital learned which types of patients surveyors would trace about a week before the survey, when the JCAHO identified to the hospital its critical focus areas. Armed with this information, department leaders helped prepare staff for the survey.

Upon arrival, the surveyors began asking for specific patient charts. On several occasions, staff had trouble locating certain charts. This put pressure on staff, since the surveyors generally expected to have the charts handed to them within a few minutes of asking for them.

When a health care professional who was involved with a tracer patient's care wasn't available (many were not on duty at the time of the surveyor's visit), surveyors usually asked to speak with a health care provider who provided similar treatment to a similar kind of patient.

Surveyors held a debriefing with hospital staff each day to discuss how meetings with the survey team had gone, what staff thought of the surveyors' approach, and what questions staff had. On the final survey day, there was no debriefing; instead, the survey team held a final interview with hospital leadership.

Overall, the hospital scored very well, although the surveyor identified a few areas for improvement. These included documentation of patient care procedures in the ICU, and the fact that the eye center had failed to make a phone call for a patient who needed a follow up appointment after a procedure.

Throughout the week, patient safety was the focus of the surveyor's questions. Most of the questions centered on the care that a particular patient received and how providers communicated with one another about it.

In the end, preparation most helped the organization. Staging a mock survey so that staff would know what to expect helped them maintain their cool during the real thing.

This story is an excerpt from the Tracer Methodology Mock Survey Training Handbook. To order copies of the handbook, click here.

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