The dates for the CALS Survey (also commonly referred to as a JCAHO visit) are Monday, April 6, through Friday, April 10, for Stanford Hospital and Clinics, said Rebecca Partridge, director of accreditation and regulatory affairs for Stanford. A separate visit for the institution's home care program will occur later, probably in May, she said.

"The reference guide, prepared by the medical staff office, contains answers to questions that practicing physicians - not just the leaders - are likely to be asked by the inspection team," said Rachel Deming, director of professional services for UCSF Stanford Health Care. It has been mailed to physicians with this issue of the Medical Staff Update and will also be available on nursing units and in the clinics. The guide, conveniently designed to fit in a physician's jacket pocket, has been organized by survey topics important to the medical staff, Deming said.

"Flip through the guide before you come to the hospital during the week of April 6, and you should be comfortable when responding to questions you're likely to be asked by a surveyor," said Larry Shuer, chief of staff.

Questions are likely to be specific but generally may be expected to fall within two general themes:

1) Institutional issues, such as the mission statement, values, performance improvement or a definition of quality.

2) Practice policies, such as conscious sedation, advance directives, restraints/ seclusion, and medication. Know the policies that relate to your practice and admission patterns.

Topics that relate to medical staff practice are addressed in the reference guide. If a medical staff member is questioned by a surveyor, answers should be consistent with good practice and hospital policy. [See examples]

"We hope that long after the survey teams leave, this guide will still be useful in providing basic information that will help us all practice here," Shuer said.

The weeklong surveys involve representatives from three groups: the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the California Medical Association (CMA) and the state Department of Health Services (DHS). The official name for the event is the Consolidated Accreditation and Licensing Survey.

Deming noted that for the first time, the results of the survey are being released on the Internet, offering the public an opportunity to compare institutions.

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