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New Leadership Standard on Managing Patient Flow for Hospitals


Promoting More Efficient Patient Movement

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 quality.”

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 630/792-5900.


Official Publication of New Standard and Elements of Performance


New Leadership Standard on Managing Patient Flow

Standard LD.3.10.10*
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

  1. Leaders assess patient flow issues within the organization, the impact on patient safety, and plan to mitigate that impact.

  2. 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.

  3. Leaders and Medical Staff share accountability to develop processes that support efficient patient flow.

  4. Planning includes the delivery of adequate care and services to those patients who are placed in overflow locations, such as hallways.

  5. Specific indicators are used to measure components of the patient flow process and include:

    1. Available supply of patient bed space

    2. Efficiency of patient care and treatment areas

    3. Safety of patient care and treatment areas

    4. support service processes that impact patient flow.

  6. Indicator results are available to those individuals who are accountable for processes that support patient flow.

  7. Indicator results are reported to leadership on a regular basis to support planning.

  8. The organization improves inefficient or unsafe processes identified by leadership as essential in the efficient movement of patients through the organization.

  9. 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



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