The Joint Commission
Quality Check
Quality Report

Summary of Accreditation Quality Information
SouthEast Alaska Regional Health Consortium
DBA: SEARHC Mt. Edgecumbe Hospital
Org ID: 10217
222 Tongass Drive
Sitka, AK  99835
(907)966-2411
www.searhc.org


Accreditation
Programs
Accreditation
Decision
Effective
Date
Last Full Survey Date Last On-Site Survey Date
Behavioral Health Care
Accredited 11/22/2013 9/18/2013   9/18/2013  
Hospital
Accredited 9/21/2013 9/20/2013   11/5/2013  


Accreditation programs recognized by the Centers for Medicare and Medicaid Services (CMS)
Hospital





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  Symbol Key
This organization achieved the best possible results
This organization’s performance is above the target range/value.
This organization’s performance is similar to the target range/value.
This organization’s performance is below the target range/value.
This measure is not applicable for this organization.
Not displayed
  Footnote Key
1. The measure or measure set was not reported.
2. The measure set does not have an overall result.
3. The number is not enough for comparison purposes.
4. The measure meets the Privacy Disclosure Threshold rule.
5. The organization scored above 90% but was below most other organizations.
6. The measure results are not statistically valid.
7. The measure results are based on a sample of patients.
8. The number of months with measure data is below the reporting requirement.
9. The measure results are temporarily suppressed pending resubmission of updated data.
10. Test Measure: a measure being evaluated for reliability of the individual data elements or awaiting National Quality Forum Endorsement.
11. There were no eligible patients that met the denominator criteria.
National Patient Safety Goals and National Quality Improvement Goals
    Compared to other Joint Commission Accredited Organizations
    Nationwide Statewide
Behavioral Health Care
2013 National Patient Safety Goals See Detail
This organization’s performance is similar to the target range/value.
This Goal is not applicable for this organization.
*
Hospital
2013 National Patient Safety Goals See Detail
This organization’s performance is similar to the target range/value.
This Goal is not applicable for this organization.
*
National Quality Improvement Goals:    
Reporting Period:
Jan  2013 -
Dec  2013
Heart Attack Care See Detail
Not displayed.
3
Not displayed.
3
Heart Failure Care See Detail
Not displayed.
3
3
Pneumonia Care See Detail
Not displayed.
3
Not displayed.
3
Surgical Care Improvement Project (SCIP)    
SCIP - Cardiac See Detail
   
SCIP - Infection Prevention
For All Reported Procedures:
See Detail
This organization’s performance is similar to the target range/value.
This organization’s performance is above the target range/value.
  • Blood Vessel Surgery
See Detail
Not displayed.
3
Not displayed.
3
  • Colon/Large Intestine Surgery
See Detail
Not displayed.
3
Not displayed.
3
  • Hysterectomy
See Detail
Not displayed.
3
Not displayed.
3
SCIP – Venous Thromboembolism (VTE) See Detail
   
 
National Quality Forum The Joint Commission only reports measures endorsed by the National Quality Forum.
 
* State results are not calculated for the National Patient Safety Goals.

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Sites and Services
* Primary Location

An organization may provide services not listed here. For more information refer to the Quality Report User Guide .

Locations of Care Available Services
SouthEast Alaska Regional Health Consortium  *
DBA:  SEARHC Mt. Edgecumbe Hospital
222 Tongass Drive
Sitka, AK  99835
    Services:
    • CT Scanner (Imaging/Diagnostic Services)
    • Ear/Nose/Throat Surgery (Surgical Services)
    • EEG/EKG/EMG Lab (Imaging/Diagnostic Services)
    • Gynecological Surgery (Surgical Services)
    • Gynecology (Inpatient)
    • Inpatient Unit (Inpatient)
    • Interventional Radiology (Imaging/Diagnostic Services)
    • Labor & Delivery (Inpatient)
    • Magnetic Resonance Imaging (Imaging/Diagnostic Services)
    • Medical /Surgical Unit (Inpatient)
    • Medical ICU (Intensive Care Unit)
    • Normal Newborn Nursery (Inpatient)
    • Outpatient Clinics (Outpatient)
    • Post Anesthesia Care Unit (PACU) (Inpatient)
    • Surgical Unit (Inpatient)
    • Teleradiology (Imaging/Diagnostic Services)
    • Ultrasound (Imaging/Diagnostic Services)
    SouthEast Alaska Regional Health Consortium
    DBA:  Raven's Way
    1200 Seward Avenue
    Sitka, AK  99835
      Services:
      • Chemical Dependency (Residential Care - Child/Youth)
      • Peer Support (Non 24 Hour Care)
      SouthEast Alaska Regional Health Consortium
      DBA:  Haa Toowoo Naakw Hit
      1209 Seward Avenue
      Sitka, AK  99835
        Services:
        • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
        SouthEast Alaska Regional Health Consortium
        DBA:  Juneau Behavioral Health
        3245 Hospital Drive
        Juneau, AK  99801
        Other Clinics/Practices located at this site:
        • Juneau Dental Clinic
        Services:
        • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
        • Outpatient Clinics (Outpatient)
        SouthEast Alaska Regional Health Consortium
        DBA:  Thorne Bay Health Clinic
        120 Freeman Drive
        Thorne Bay, AK  99919
          Services:
          • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
          • Outpatient Clinics (Outpatient)
          • Peer Support (Non 24 Hour Care)
          SouthEast Alaska Regional Health Consortium
          DBA:  Pelican Health Center
          167 Salmon Way
          Pelican, AK  99832
            Services:
            • Outpatient Clinics (Outpatient)
            SouthEast Alaska Regional Health Consortium
            DBA:  Kasaan Health Clinic
            First and Jones
            Kasaan, AK  99950
              Services:
              • Outpatient Clinics (Outpatient)
              SouthEast Alaska Regional Health Consortium
              DBA:  Klukwan Health Center
              11 Chilkat Avenue
              Haines, AK  99827
                Services:
                • Outpatient Clinics (Outpatient)
                SouthEast Alaska Regional Health Consortium
                DBA:  Angoon Health Clinic
                725 Relay Road
                Angoon, AK  99820
                  Services:
                  • Administration of High Risk Medications (Outpatient)
                  • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                  • Outpatient Clinics (Outpatient)
                  SouthEast Alaska Regional Health Consortium
                  DBA:  Hoonah Health Center
                  568 Raven Drive
                  Hoonah, AK  99829
                    Services:
                    • Administration of High Risk Medications (Outpatient)
                    • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                    • Outpatient Clinics (Outpatient)
                    SouthEast Alaska Regional Health Consortium
                    DBA:  Juneau Medical Clinic
                    1200 Salmon Creek Lane
                    Juneau, AK  99801
                      Services:
                      • Administration of High Risk Medications (Outpatient)
                      • Outpatient Clinics (Outpatient)
                      • Perform Invasive Procedure (Outpatient)
                      SouthEast Alaska Regional Health Consortium
                      DBA:  Alicia Roberts Medical Center
                      7300 Klawock-Hollis Highway
                      Klawock, AK  99925
                        Services:
                        • Administration of High Risk Medications (Outpatient)
                        • Anesthesia (Outpatient)
                        • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                        • Outpatient Clinics (Outpatient)
                        • Peer Support (Non 24 Hour Care)
                        • Perform Invasive Procedure (Outpatient)
                        SouthEast Alaska Regional Health Consortium
                        DBA:  Hydaburg Health Center
                        Eight Street Extension
                        Hydaburg, AK  99922
                          Services:
                          • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                          • Outpatient Clinics (Outpatient)
                          SouthEast Alaska Regional Health Consortium
                          DBA:  Kake Health Center
                          105 Totem Way
                          Kake, AK  99830
                            Services:
                            • Administration of High Risk Medications (Outpatient)
                            • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                            • Outpatient Clinics (Outpatient)
                            SouthEast Alaska Regional Health Consortium
                            DBA:  Haines Medical Clinic
                            131 First Avenue South
                            Haines, AK  99827
                              Services:
                              • Administration of High Risk Medications (Outpatient)
                              • Anesthesia (Outpatient)
                              • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                              • Outpatient Clinics (Outpatient)
                              • Perform Invasive Procedure (Outpatient)
                              SouthEast Alaska Regional Health Consortium
                              DBA:  Mt. Edgecumbe High School
                              1293 Seward Avenue
                              Sitka, AK  99835
                                Services:
                                • Outpatient Clinics (Outpatient)
                                SouthEast Alaska Regional Health Consortium
                                DBA:  Haines Behavioral Health
                                77 Beach Road
                                Haines, AK  99827
                                  Services:
                                  • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                                  SouthEast Alaska Regional Health Consortium
                                  DBA:  Prince of Wales Eye Clinic
                                  6488 Klawock-Hollis Highway #4
                                  Klawock, AK  99925
                                    Services:
                                    • Outpatient Clinics (Outpatient)
                                    SouthEast Alaska Regional Health Consortium
                                    DBA:  Craig Behavioral Health
                                    1305 Craig-Klawock Hwy
                                    Craig, AK  99921
                                      Services:
                                      • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)
                                      • Peer Support (Non 24 Hour Care)
                                      SouthEast Alaska Regional Health Consortium
                                      DBA:  Petersburg Behavioral Health
                                      202 Gjoa Street
                                      Petersburg, AK  99833
                                        Services:
                                        • Behavioral Health (Non 24 Hour Care - Adult/Child/Youth)

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