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Report Explains New ED-Focused Patient Flow Requirements for Hospitals

The Joint Commission has released an "RReport" on the requirement, rationale and references for its updated "Leadership" standards for patient flow in hospitals, in particular the patient flow through the emergency department.

Although overcrowding and patient boarding in the emergency department have drawn widespread attention, Joint Commission officials say the revised standards make it clear that the flow of patients must be managed systematically throughout the entire hospital.

The RReport is thus designed to give accredited organizations a deeper understanding of the elements of performance in the standards that were revised and developed to enhance patient safety by addressing:

  • the use of data and metrics to better manage patient flow as a hospital-wide concern;
  • the safe provision of care for patients should boarding occur; and
  • mitigating risks experienced by patients with psychiatric emergencies who are boarded in the ED.

The patient flow standards were revised using input gathered through surveys of The Joint Commission's Hospital Advisory Committee and Joint Commission hospital surveyors, as well as reviews of scoring and Requirement for Improvement (RFI) data from accreditation surveys.

The Joint Commission also worked with key external experts, including representatives from the American College of Emergency Physicians, the American Hospital Association, the Emergency Department Benchmarking Alliance, the Emergency Nurses Association, the National Association of Public Hospitals and Health Systems, the Institute for Behavioral Healthcare Improvement, and Urgent Matters.

In addition, The Joint Commission considered feedback from the 2011 SAMHSA (Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services) national conference and from conference calls with community behavioral health providers on community/hospital collaboration.

The Joint Commission also conducted seven learning visits at accredited hospitals, a formal field review of the proposed standards and three pilot tests at accredited hospitals as part of the standards and survey development process.

The resulting revised elements of performance go into effect Jan. 1, 2013, with two exceptions: Leadership (LD) standard LD.04.03.11 elements of performance six and nine will be effective Jan. 1, 2014. They will be included in the 2013 standards manual, but will not affect the organization's accreditation decision. Information on the implementation of these requirements will be collected by Joint Commission surveyors and staff throughout 2013, and will be used to inform the survey process.

To view the "RReport" on the revised patient flow standards, visit  or sign-up to receive the publication by e-mail.             


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