Effective January 1, 2014, hospitals, accredited by the Joint Commission, will be required to meet the elements of performance (EPs) related to boarding and leadership collaboration for behavioral health patients, as part of The Joint Commission’s revised standard for managing the flow of patients through the emergency department. Overcrowding and patient boarding in the emergency department has drawn considerable attention recently (see e.g., Seattle Times article on psychiatric boarding), and The Joint Commission recognizes that the problems with patient flow may have multiple factors and stem from other areas within and outside the hospital, not just the emergency department.
Under Leadership Standard LD.04.03.11 or the “Patient Flow” Standard, the following EPs will go into effect for hospitals starting next year:
- EP 6. The hospital measures and sets goals for mitigating and managing the boarding of patients who come through the emergency department. Note: Boarding is the practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made. The hospital should set its goals with attention to patient acuity and best practice; it is recommended that boarding time frames not exceed 4 hours in the interest of patient safety and quality of care.
- EP 9. When the hospital determines that it has a population at risk for boarding due to behavioral health emergencies, hospital leaders communicate with behavioral health care providers and/or authorities serving the community to foster coordination of care for this population.
The Joint Commission notes that the four-hour time frame referenced in EP 6 serves as a guideline (not a requirement) to help the hospital set a reasonable goal for its institution. Also, the goal of EP 9 is to “facilitate the more efficient use of limited resources, and build leverage to implement more effective systems of care for individuals at risk of psychiatric emergencies.” Though the communication required in EP 9 will vary depending on the nature of the relationship, The Joint Commission advises that “such communication should occur at least annually and may range from conference calls and correspondence to meetings, education forums, and strategic working groups.”
EP 6 and EP 9 are in addition to the revised EPs that went into effect at the beginning of this year on January 1, 2013. The other revisions address: the use of data and measures to identify, mitigate and manage issues affecting patient flow; the management of emergency department throughput as a system-wide issue; and the environment of care, staffing, assessment, reassessment and care for patients with behavioral health emergencies.
To help organizations implement these requirements, The Joint Commission released an “R3 Report on Patient Flow through the Emergency Department” that provides the requirement, rationale and references for the updated standards. If you have questions about these accreditation standards, please contact Don Black or Jefferson Lin.