Home | Business News | Browse by Publication | M | Modern Healthcare

Going with the (patient) flow; JCAHO's 'watered down' ER patient-management standard relieves hospital executives, disappoints docs.

Article Excerpt
Byline: John Morrissey

To the relief of hospital executives but the dismay of emergency physicians, the Joint Commission on Accreditation of Healthcare Organizations agreed that hospitals can only do so much to attack the problem of emergency room overcrowding and should focus instead on managing patient flow generally within a facility, including the ER.

The JCAHO issued a proposed standard in May 2003 requiring a series of improvements in ER patient management to reduce the odds of catastrophic delays in treatment stemming from overcrowded conditions. The proposal grew out of a national symposium on ER problems convened by the commission in February 2003, which followed an alert it issued in July 2002 tying treatment delays to more than 50 deaths.

But the final standard, published without fanfare in the February issue of the JCAHO's Perspectives, relieved the nation's hospitals of direct responsibility for troubleshooting patient-capacity problems that originate with community agencies that send the ill and injured to an ER or receive hospitalized patients after discharge.

The revisions also removed directives specifically intended to curb practices in and around the ER that contribute to unsafe conditions, such as putting patients in hallways or other locations near the emergency area until an actual bed becomes available.

First proposed as "Emergency Department Overcrowding Standards,'' the original draft went through a metamorphosis so complete that the heading on the final version did not mention the emergency department at all.

"We're...