ED Accreditation Update

Ensure compliance with environment of care

As census grows, so do potential problems 

As EDs have grown and become overcrowded, environment of care issues also have grown, particularly security concerns, says Dean Samet, associate director/senior engineer of accreditation operations/Standards Interpretation Group at the Joint Commission.

"In recent years, there have been a number of incidents where the gang-related activities or domestic problems are brought right into the ED," he says.

Review logistics and make adjustments

To comply with environment of care standards, assess your logistics and past history of incidents, and make adjustments as needed, Samet advises.

You may want to consult with law enforcement personnel, he says.

Also, obtain input from your peers at other facilities, particular ones in heavily populated areas that are more likely to encounter such problems, Samet says.

The Joint Commission is looking at security for patients, security for employees, and security for visitors, says Eileen Whalen, MHA, RN, vice president of emergency, trauma, and perioperative services at University Medical Center in Tucson, AZ.

You should have panic alarms in the triage rooms and any other room where a staff member is locked in or closed in, Whalen says. Also, verify that your panic alarms are working, she advises.

Another problem with overcrowding is lack of privacy with hallway beds, Whalen points out. Also, expect surveyors to ask how you ensure privacy in rooms that simply have a curtain pulled, she says.

"Your staff members need to have scripted responses to a site reviewer: We speak in a modulated tone. If we have something we need to talk to the family about something that’s very confidential, we step out into the greeting rooms,’ or the nurse manager’s office, social worker’s office, or wherever it may be," Whalen says.

Consider her other tips for compliance with environment of care standards:

• Emergency preparedness.

— Have an inclusive bioterrorism plan that addresses various emergencies and explains all staff members’ involvement.

— Conduct drills, and document the drills if that is the responsibility of the ED manager. Document when the drills were, who was available, and how you coordinated it with others.

— Ensure that your bioterrorism plans follows the methodology of the Hospital Emergency Incident Command System (HEICS), which is a generic crisis management plan expressly for comprehensive medical facilities. Explain how your bioterrorism plan is implemented with community resources and how other hospitals are involved.

• Environmental hazards.

— Don’t have intravenous setups or open syringes in patient rooms.

— Don’t have open needles, even if it’s a needless system.

— Secure all knives (including any kept around simply for cutting up birthday cakes).

• Signage.

— Drive around as if you were a patient, and see if you can find the ED.

— Ensure that the signs have the same language as your license. For example, if your license says you are a basic "emergency/trauma center," that wording should be on the signs.

— Publish the signs in every language you serve in your community.

• Access.

— Ensure staff and physicians don’t impede access by parking in the ED patient parking lot.

— Ensure patients, and family members escorting patients with dementia-related diseases, can easily access the ED.


— Inspect the hospital grounds at night.

— Perform a deep cleaning if you haven’t done so recently.

— Walk through your department with your environmental service staff and engineering staff. Determine what lighting works, and ensure all areas are well-lit.

• Contamination.

— Ensure dirty and clean items are separated into the correct designated utility rooms.

— Educate your nurses to discard material down a sink only if there isn’t a patient in the room.

• Patient flow.

— Obtain knowledge and educate your staff about your experiences with diversion, your process to prevent it, and your policies and procedures.

— Be prepared to explain how you work with your emergency medical services (EMS) community. Surveyors may pull aside EMS staff to obtain their input.

— Ensure your charge nurse knows your turnaround times and diversion data.

"If you’ve been on diversion in the 24 hours prior to [the survey], you’d sure as heck better know why," Whalen adds.