Excerpt from The Joint Commission eNewsletter, March 10, 2006 Subject: Reduce Overcrowding and Increase Patient Safety

Overcrowding and Patient Safety

According to the American College of Emergency Physicians®, overcrowding occurs when the need for emergency services outstrips available resources in the unit. This happens when there are more patients than staffed emergency department (ED) treatment beds and wait times exceed reasonable periods. Overcrowding usually results in patients being monitored in non-treatment areas, such as hallways, while waiting for ED treatment or inpatient beds.

Managing patient flow can eliminate factors that lead to ED overcrowding. Here are some strategies to improve your hospital's patient flow and thereby also improve patient safety:

— Appoint a designated physician or advanced practice nurse as a "bed czar" whose primary responsibility is to account for beds and work with housekeeping to quickly turn them over.

This person should have the authority to:

• Make decisions on inpatient bed transfers and discharges.
• Notify relevant medical staff of an impending patient overload.
• Cancel elective admissions, elective surgeries, and scheduled diagnostic procedures.
• Divert ambulances after consulting with others.

— Form a "bed briefing group" that discusses the admissions scheduled for the day, the number of patients who need to be placed from the ED, and the types of inpatient beds expected to become available. The group should have representation from the ED, inpatient units (such as critical care), nursing management, administration, relevant diagnostic and therapy departments, pharmacy, and environmental services.

— Use a patient computer tracking system to follow patients' movements throughout the ED, including how long it takes for patients to get registered, see a physician, be treated and tested, and either discharged or admitted. These systems provide real-time access to accurately determine ED occupancy and capacity.

— Use a unit assessment tool to determine current capacity in units throughout the hospital, not just in the ED. The tool uses real-time data to identify when the unit lacks any capacity to accept additional patients without risking safety for patients or burnout of staff.

— Use performance measures to improve patient flow. The Agency for Healthcare Research and Quality developed 38 measures focusing on seven areas: patient demand, ED capacity, patient complexity, ED efficiency, ED workload, hospital efficiency, and hospital capacity.¹

For more information on The Joint Commission, visit www.jointcommission.org.

Versus provides solutions for both patient computer tracking and the collection of real-time data to improve patient throughput and patient safety. Click here to visit the Patient Tracking Solutions section of our website.

1 "Overcrowding and Patient Safety". Joint Commission Resources [electronic newsletter]. Oakbrook, IL: Joint Commission Resources, Inc., March 10, 2006.