The Joint Commission is continuing its focus on reducing emergency department boarding with the introduction of additional standards aimed at improving the flow of patients throughout the hospital.
In performance standards that went into effect on Jan. 1, the Joint Commission is requiring its accredited hospitals to measure and set goals for "mitigating and managing" the boarding of patients who come through the emergency department. And the organization recommends that hospitals try to limit boarding to no more than 4 hours after the decision to admit or transfer has been made, though the 4-hour time frame is a guideline and hospitals won’t be scored on whether they can meet it.
Dr. Frederick C. Blum
The Joint Commission is also requiring hospitals to do more to curb the boarding of patients with mental health or substance abuse emergencies in particular. In a new standard that took effect on Jan. 1, hospital leaders are required to reach out to behavioral health care providers in the community whenever they encounter patients at risk for boarding due to a behavioral health emergency.
The new standards come a year after hospitals were asked to make reducing boarding in the ED, a hospital-wide mission by setting specific goals on ensuring the availability of patient beds and maintaining proper throughput in laboratories, operating rooms, inpatient units, telemetry, radiology, and the postanesthesia-care unit. Also in 2013, hospitals were asked to create a safe, monitored location to board behavioral health patients awaiting treatment.
The standards are mostly good news for emergency physicians, said Dr. Frederick C. Blum, a past president of the American College of Emergency Physicians and an attending physician in the department of emergency medicine at West Virginia University in Morgantown, because they pull the hospital leadership into the issues of ED boarding in general and how to handle boarding of behavioral health patients.
"Previously, the hospitals have not given this issue as much attention," he said. "This at least makes them partners with us to try solve this problem of ED boarding."
But even with the whole hospital behind the problem, it will remain a challenge, Dr. Blum said. One complicating factor is the Affordable Care Act. No one knows for sure how the ACA will change the volume of patients coming to the ED, Dr. Blum said, and hospitals still have to deal with persistent problems such as the shortage of hospital beds.
Dr. David Yu
For hospitalists, the increased focus on patient flow could bring some major changes, according to Dr. David Yu, medical director of the adult inpatient medicine service at Presbyterian Medical Group in Albuquerque, N.M.
Currently, hospitalist groups are structured financially for maximum productivity not patient flow. And, as a result, efficiently discharging patients and freeing up hospital beds isn’t a top priority for hospitalists, he said.
"It’s going to be a paradigm shift," Dr. Yu said.
To get hospitalists and other specialists in the hospital focused on improving patient flow, hospital leaders will need to switch up the financial incentives and set a hospital-wide budget that makes patient flow a priority, Dr. Yu said.
mschneider@frontlinemedcom.com
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