Hospital leaders should develop plans to mitigate emergency department overcrowding, says the Joint Commission on Accreditation of Healthcare Organizations in a proposed new standard.
JCAHO says overcrowding in emergency departments increases risk for patient safety and healthcare quality problems. It is asking for public comment on its draft standards, which would be placed in the leadership chapter of the Joint Commission's Comprehensive Accreditation Manual for Hospitals.
"We're very content with the proposed standards, which reflect the Joint Commission's understanding of emergency room overcrowding as a leadership issue," says Susan Nedza, M.D., a member of the board of directors of the American College of Emergency Physicians.
The commission says causes of emergency department overcrowding include:
- scarcity of available inpatient beds and alternate care settings
- increased competition for services within the organization
- nursing and other clinical staffing shortages
- decreased number of emergency departments
- saturation of primary care networks
These include planning for care of patients placed in temporary beds that must be outside the ED. Discharges should be expedited by coordinating with community resources, such as long-term care facilities, home health agencies and other hospitals.
"(The standards) also recognize ED crowding is just not an ED problem, it's a community access-to-care problem," says Nedza, a faculty member of the Feinberg School of Medicine at Northwestern University in Chicago.
Under the proposed standards, ED crowding factors also would be taken into account in performance measurement and would have to become part of organization-wide performance improvement activities.
The draft standards and an online review form are available at the JCAHO Web site. The deadline for submission of comments is June 2.