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Don’t put patients in egress halls when ED overcrowds: The Joint Commission is against such actions


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Those who plan to move patients into exit corridors when routine ED overcrowding occurs may want to reconsider, given what a Joint Commission official said about the matter.

Patients on gurneys and chairs cannot be parked in egress corridors because of Life Safety Code® requirements for minimum clear widths, George Mills, FASHE, CEM, CHFM, senior engineer at The Joint Commission (formerly JCAHO), said during a Joint Commission Resources audio conference May 6.

Even if state regulators order healthcare facilities to get patients out of EDs and hold them in inpatient unit corridors, The Joint Commission doesn’t think this is the best approach, Mills said.

Instead, facility managers and ED directors should review ED traffic flow and come up with better ways to manage overcrowding.

An exception to this requirement is a disaster-related influx of patients to a healthcare facility, during which corridor treatment of patients may be the only way to deal with the sudden surge.

Dealing with ED overcrowding

The issue of what to do about overflowing EDs is contentious. The Massachusetts Nurses Association clashed earlier this year with Saint Vincent Hospital in Worcester, MA, about putting patients awaiting discharge in hallways to make room for ED patients waiting to be admitted.

Saint Vincent’s move came in reaction to the state Department of Health’s January edict that hospitals can’t divert ambulances to other healthcare facilities to avoid ED overcrowding.

Saint Vincent’s policy of moving patients awaiting discharge into hallways has been used at least once this year. “A patient who was awaiting discharge was moved from his room to the hallway adjacent to the nurses’ station in order to make his bed available for an admitted ED patient, who required treatment on the inpatient telemetry unit,” the hospital said in a statement.

The Joint Commission’s stance is a surprise to Dennis Irish, spokesperson for Saint Vincent, especially given that the Massachusetts Department of Health and the state fire marshal have stated that patient boarding in hallways can work within fire safety requirements.

In a letter to local fire chiefs that was posted online, the Massachusetts fire marshal notes the Department of Health’s new overcrowding policy. The letter asks chiefs to work closely with hospitals in their communities to understand defend-in-place and egress strategies in the event patients are boarded in corridors.

Saint Vincent’s policy is to put boarded patients in wheeled chairs, not gurneys, in the hallways on the rare occasions when the ED is in danger of being overpopulated, Irish says. “It’s a last resort,” he added. “It’s only happened once.”

Before boarding patients in corridors, the hospital takes other steps, such as attempting to open more beds on care units.

Saint Vincent’s efforts have met with approval from state regulators, Irish said. It’s possible this issue will come to a head the next time The Joint Commission surveys the facility based on the differences between the state’s and the commission’s stances, he said.

Generally, The Joint Commission expects facilities to observe the stricter of two approaches when there is a conflict in requirements. Given how controver- sial ED overcrowding has become in the industry, it is worth comparing The Joint Commission’s opinion to the overcrowding procedures your facility currently engages in.

Source

Adapted from Healthcare Life Safety Compliance, July 2009, HCPro, Inc.