The Joint Commission on Accreditation of Healthcare Organizations has quietly de-emphasized emergency room overcrowding as the cause of treatment delays and inadequate care nine months after singling out the issue as a safety problem. Instead, a new accreditation standard directs hospital leaders to identify and mitigate barriers to efficient patient flow throughout their facilities. A draft standard proposed last May accompanied the JCAHO's highly public push to adopt ER crowding as the third initiative in its campaign to influence public policy affecting quality of care. The proposed standard met immediate criticism that many sources of ER overcrowding were outside the direct control of hospitals.
After reviewing public comments, the commission modified the standard to emphasize the role of leadership in motivating people throughout the hospital to expedite the movement of patients in general, according to the February issue of Perspectives, a monthly JCAHO publication. "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," said Robert Wise, the commission's vice president of standards, in an article accompanying publication of the approved standard. Unlike the proposed standard, the final revision received no mention except for the official notice in the back of the February magazine. -- by John Morrissey