Keeping patients waiting around for their care or sending them to the wrong part of the hospital aren’t just annoying nuisances for the consumer. Poor patient flow can potentially harm or even kill patients, not to mention the damaging ripple effect it can have across the hospital.
Coordinating care will become all the more important as new patients, unfamiliar with the intricacies of a complicated health care maze, acquire health insurance and enter the delivery system. Already-slammed emergency rooms are about to get even busier. Twenty-five states are expanding Medicaid, and one study released this month estimated that Medicaid use increases visits to the ED by about 40 percent.
With all that and more in mind, new Joint Commission standards related to patient flow went into effect on Jan. 1. Those include requiring accredited hospitals to measure and set goals on how long patients are held in the ED without being admitted, and addressing the risks of boarding patients with behavioral or substance abuse issues.
"Patients continue to use the emergency department, and there’s some anxiety, with increased access due to the Affordable Care Act, that emergency department volume actually will increase, and that’s certainly something that would be very, very problematic," Ann Scott Blouin, R.N., executive vice president of customer relations for the Joint Commission, said during a webinar Friday.
The commission already had some standards in place, but officials there felt it "wasn’t quite enough," and they wanted to take a closer look at boarding and overcrowding, officials said on the call. So, they’ve done a wealth of work, hoping to get to the bottom of the issue — exploring the history of patient flow standards, sorting through literature, chatting with surveyors, holding conference calls with experts, visiting seven accredited hospitals, and hosting pilot projects at three of those locations.
Cynthia Leslie, R.N., associate director of the commission’s Standards Interpretation Group, pointed out during the webinar the persistence of the problem, despite its importance. One survey of ED directors found that 79 percent reported that they had boarded those with psychiatric emergencies, and 33 percent of patients requiring admission were boarded for more than eight hours. The financial implications can be severe as I mentioned earlier — each patient who leaves without being seen costs a hospital as much as $500 in lost revenue; each psychiatric patient boarding costs $2,264 extra each case; and each ambulance diverted because of a lack of available beds results in more than $3,000 in lost revenue.
I’m not going to get too deep into the weeds about all the different standards, but this newsletter has a pretty good breakdown of all the details. A good place to get started, though, is by taking your hospital’s pulse and measuring how you’re performing on patient flow. Good areas to assess, according to the Joint Commission, include the available supply of beds, throughput areas where patients receive care, and the efficiency of nonclinical services that could delay care, such as housekeeping and transportation. Poor patient flow in the ED is rarely a problem caused solely by the department, and usually stems from bottlenecks in other areas, along with problems outside of the hospital such as a lack of access to a PCP or mental health resources.
With such a complicated, systemwide issue, it’s critical that hospital leaders make patient flow a priority. "The leaders are the ones who are going to set the culture in your organization," Leslie said.
For further reading, you can also check out the H&HN Daily archives on our shiny new website. Here’s a cover story I wrote in November exploring how top health systems are trimming down wait times, including in the ED. As always, please share your thoughts in the comment section, through email or via Twitter.