The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) just released its new Leadership standard to address "Managing Patient Flow." Originally titled "Emergency Department Overcrowding" when it was released as a proposed standard last year, the JCAHO has revised it significantly based on many comments from the hospital industry during the public review period. The new standard becomes effective 1/1/05.

“Poorly managing patient flow can impact vulnerable areas, such as the emergency department, where overcrowding can occur and create an environment with patient safety issues” says Robert A. Wise, M.D., JCAHO’s vice president for standards.

The language of the new standard acknowledges the fact that many of the reasons for ED overcrowding reside elsewhere in the institution.  Effective “Leadership” action is necessary to address these interdepartmental issues.

“While the emergency department is a vulnerable area when patient flow issues occur, the improvements needed lie in organizationwide changes rather than changes solely in the emergency department,” notes Dr. Wise.

The standard specifically addresses patients being held in “temporary bed locations” (i.e. the ED) and in “overflow” locations (i.e. hallways).

The standard will appear in the Leadership chapter of the 2005 Hospital Accreditation Manual. It states:

"LD.3.3.10.10  The leaders develop and implement plans to identify and mitigate impediments to efficient patient flow throughout the hospital."

The standard requires hospital leadership to address:

• Patient flow issues throughout the hospital, including "impact on patient safety"

• Patient care in "temporary bed locations" (Emergency Room and others)

• Shared accountability between Administration and Medical Staff for patient flow processes

• Patient care in "overflow locations, such as hallways"

• Use of "specific indicators" to "measure components of the patient flow process" and monitor capacity, support service processes and safety of hospital services and areas that receive patients

• Improvement of inefficient or unsafe processes

• Criteria for diversion decisions

Link to Full Text

Link to our JCAHO Section

Link to our ED Overcrowding and Diversion Class