Standard on Managing Patient Flow for Hospitals
Promoting More Efficient
The Joint Commission’s Standards and Survey Procedures (SSP) Committee
approved a new “Leadership” standard relating to efficient patient flow
throughout the organization. The standard, which becomes effective for all
accredited hospitals on January 1, 2005, calls on hospital leadership to develop
and implement plans to identify and mitigate issues in a hospital that can
interfere with efficient movement of patients across the continuum of care
within an organization.
“Poorly managing patient flow can impact vulnerable areas, such as the
emergency department, where overcrowding can occur and create an environment
with patient safety issues” says Robert A. Wise, M.D., JCAHO’s vice president
for standards. “This new standard will help a hospital manage how patients move
through an organization from assessment for possible admission to discharge and
identify ways that efficient patient flow directly impacts patient safety and
The Joint Commission developed this new standard in response to growing
concerns from the health care field about increasing patient congestion over the
past several years, particularly in urban and underserved areas. Problems with
patient flow can lead to sentinel events due to delays in treatment.
The approval of this new standard followed a June 2003 field review of a
proposed standard that addressed emergency department overcrowding. After
analyzing respondents’ comments, JCAHO staff modified the standard to reinforce
the concept that organization leaders must mobilize and motivate departments and
individuals throughout the organization to better govern overall patient flow.
“While the emergency department is a vulnerable area when patient flow issues
occur, the improvements needed lie in organizationwide changes rather than
changes solely in the emergency department,” notes Dr. Wise.
This new “Leadership” standard is provided in the
box below. Questions about this standard should be directed to
JCAHO’s Standard’s Interpretation Group through its online question form at
Official Publication of New Standard and Elements of Performance
New Leadership Standard on Managing
The leaders develop and implement plans to identify and mitigate impediments
to efficient patient flow throughout the hospital.
Rationale for LD.3.10.10
Managing the flow of patients through their care is essential to the
prevention of patient crowding, a problem that can lead to lapses in patient
safety and quality of care. The Emergency Department is particularly
vulnerable to experiencing negative effects of inefficiency in the
management of this process. For this reason, while Emergency Departments
have little control over the volume and type of patient arrivals and most
hospitals have lost the “surge capacity” that existed at one time to manage
the elastic nature of emergency admissions, other opportunities for
improvement do exist. Improved management of processes can ensure the wise
use of limited resources and thereby reduce the risk to patients of negative
outcomes from delays in the delivery of care, treatment, or services.
To understand the system implications of the issues, leadership should
identify all of the processes critical to patient flow through the hospital
system from the time the patient arrives, through admitting, patient
assessment and treatment, and discharge. Supporting processes are included
if identified by leadership as impacting patient flow, e.g. diagnostic,
communication, and patient transportation procedures. Relevant measurements
are selected and implemented to enable monitoring of each process and
supporting process(es) by the organization leaders. These critical processes
should be modified for the purposes of improving patient flow.
Elements of Performance for LD.3.10.10
Leaders assess patient flow issues within the organization, the
impact on patient safety, and plan to mitigate that impact.
Planning encompasses the delivery of appropriate and adequate care
to admitted patients who must be held in temporary bed locations, e.g.
Post Anesthesia Care Unit and Emergency Department areas.
Leaders and Medical Staff share accountability to develop processes
that support efficient patient flow.
Planning includes the delivery of adequate care and services to
those patients who are placed in overflow locations, such as hallways.
Specific indicators are used to measure components of the patient
flow process and include:
Available supply of patient bed space
Efficiency of patient care and treatment areas
Safety of patient care and treatment areas
support service processes that impact patient flow.
Indicator results are available to those individuals who are
accountable for processes that support patient flow.
Indicator results are reported to leadership on a regular basis to
The organization improves inefficient or unsafe processes
identified by leadership as essential in the efficient movement of
patients through the organization.
Criteria are defined to guide decisions about initiating diversion.
* This standard follows LD.3.10 (formerly LD.3.4), “The leaders
engage in both short-term and long term planning.”
Joint Commission Perspectives, February 2004, Volume 24, Number 2