2024 ANNUAL REPORT
2024 ANNUAL REPORT
BUILDING BRIDGES
BRIDGES TO IMPROVEMENT ACUTE CARE PROGRAMS Survey findings identify where to focus for improvement.
acute care hospitals
0%
100%
13%
36%
10% 11%
29%
Administrative The proportion of deficiencies under Facilities Management decreased in 2024 compared to the prior year. Quality and Risk Management deficiencies increased correspondingly. All other categories were unchanged. Facilities Management Direct Patient Care Ancillary Patient Care Services Quality & Risk Management
ACHC reviews the most frequently-cited standards in our annual Surveyor – Quality Review Editions . Here, we take a bird’s-eye view of compliance trends for services and operational functions by category. Charts on the following pages show how the total deficiencies were distributed for a specific setting. Legends identify which chapters are included in each category. You may want to consider a QAPI focus on a high-percentage category. Beyond correcting individual standard deficiencies, this approach encourages more cross-departmental collaboration to meet goals for quality.
Facilities Management Chapters 9, 11, 13
Direct Patient Care Chapters 16, 17, 18, 20, 26, 27, 30, 31, 33, 34
Administrative Chapters 1, 2, 3, 4, 6
Ancillary Patient Care Services Chapters 14, 19, 21, 22, 23, 24, 25, 32
Quality & Risk Management Chapters 7, 12, 15
ambulatory surgery centers
0%
100%
31%
24%
17%
18%
9%
Administrative Administration and Facilities Management standards continue to represent the biggest opportunities in ASCs but standards related to patient care (direct and ancillary) grew from 25% to 35% in 2024). Quality & Risk Management represented a significantly smaller share of overall deficiencies in 2024. Facilities Management Direct Patient Care Ancillary Patient Care Services Quality & Risk Management
Facilities Management Chapters 7, 15, 16
Direct Patient Care Chapters 9, 10, 11
Administrative Chapters 1, 2, 3, 8
Ancillary Patient Care Services Chapters 12, 13, 14
Quality & Risk Management Chapters 4, 5, 6
12
13
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