JCAHO standard to address crowded EDs

Board to look at field review, then decide

Access managers with responsibility for emergency department (ED) registration will want to be aware of the proposed new ED overcrowding standard from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that could become effective in early 2004.

The field review for the standard ended in June, notes Char Hill, JCAHO media relations manager. "The draft standard will be reviewed by JCAHO board members. They will consider comments from the field review before they take final action to approve, not approve, or approve a modified version of the standard for implementation."

The draft standard specifies that "leaders develop and implement plans to identify and mitigate situations that result in ED overcrowding."

The rationale for the standard is as follows:

"Patients in overcrowded EDs are at high risk of experiencing treatment delays or inadequate care. Because this patient population is particularly vulnerable to the effects of overcrowding, it is incumbent on hospital leadership to engage in the level and scope of planning needed to prevent overcrowding when possible, and to minimize its impact when it is unavoidable.

"Throughout the country," the rationale continues, "many causes interact to create overcrowded ED conditions."

Those causes include:

  • increased scarcity of available inpatient and long-term care beds and alternate care settings;
  • increased competition for services within the organization, thus intensifying overall demand for ancillary services and increasing service response time;
  • shortage of nurses and other clinical personnel;
  • decreased number of EDs;
  • saturation of the primary care network for both insured and uninsured patients.

Elements of Performance for the standard include the following action points:

  • engaging in planning that assesses the scope and impact of ED overcrowding and seeks to resolve identified issues;
  • planning encompasses the delivery of care to patients who must be placed in temporary bed locations. These temporary locations must be outside the ED and in an appropriate patient care area;
  • planning includes coordination with community resources — for example, long-term care facilities, home health agencies, and other hospitals — for the purpose of expediting discharges from the ED. Would the ED benefit from a social worker?
  • measuring specific performance indicators that monitor the capacity of support services and patient care and treatment areas that receive ED patients;
  • integrating the organization’s handling of ED overcrowding into organizationwide performance improvement activities;
  • developing performance measures that monitor the effectiveness of the plan’s implementation;
  • including methods to minimize diversion through coordination with community resources such as emergency medicine services, air ambulances, or fire departments.