The Joint Commission's New Patient Flow Standards

The Joint Commission accredits about 82% of the hospitals in the United States. Any hospital accredited by the Joint Commission must be in compliance with all of their standards. The Joint Commission has standards on patient flow to prevent crowding and boarding of patients in the emergency department (ED) and in other temporary locations.Revisions addressing patient flow through the ED include hospital leadership’s use of data and measures to identify, mitigate and manage patient flow issues as well as management of ED throughput as a system wide issue. Additional revisions include safety for boarded patients and leadership communication with behavioral health providers to ensure coordinated care. Boarding of psychiatric patients has increased and has been especially problematic in EDs.

https://smhs.gwu.edu/urgentmatters/news/joint-commissions-new-patient-flow-standards 

Emergency department overcrowding and access block

Emergency department overcrowding (EDOC) is defined as a situation where the demand for emergency services exceeds the ability of an emergency department (ED) to provide quality care within appropriate time frames.

1,2

ED overcrowding has been a key issue in Emergency Medicine in Canada for more than 20 years.Despite increased political, administrative, and public awareness, EDOC situations continue to rise infrequency and severity. Patient suffering, prolongedait times, deteriorating levels of service, adverse patient outcomes and the ability to retain experienced staff in an ED are all ill effects of this ongoing problem.

http://caep.ca/sites/caep.ca/files/caep/PositionStatments/edoc_document_final_eng.pdf

Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

 ⇛The Emergency Department (ED) is one of the most overcrowded units in the inpatient service delivery system. Delays in services in the ED may have unpleasant consequences for patients.[1] Crowding in the ED is defined as having more patients than treatment rooms or more patients than staff should ideally care for, and overcrowding was defined as dangerously crowded, with an extreme volume of patients in ED treatment areas which forces the ED to operate beyond its capacity.2, 3

In the Emergency Medicine literature, overcrowding in EDs is described as a major public health problem due to degradation of the quality of care (prolonged waiting times, delays to diagnosis and treatment, delays in treating seriously ill patients), increased costs (leading to unnecessary diagnostic investigations), and patients’ dissatisfaction.4, 5 Although the most important cause of bottleneck in the ED seems to be a growing population with non-urgent complaints. Overcrowding in EDs is a multi-factorial problem worldwide, occurring as a result of prolonged length of stay (LOS) in the ED, inadequate healthcare personnel appointment, delayed response to ED consultations, repeated ED visits (including inappropriate use), and hospital-specific factors (size and location, lack of available inpatient beds). In this article, we investigated ED systems of different countries and aimed to find a solution to overcrowding in the ED in the light of statistical data of Samsun Education and Research Hospital (SERH) Emergency Department. We also presented our recommendations to prevent overcrowding in the ED.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909875/ 

Critérios para admissão em UTI

O Conselho Federal de Medicina (CFM) publicou nesta quinta-feira (17), no Diário de Oficial da União, a Resolução CFM nº 2.156/2016, que estabelece os critérios para indicação de admissão ou de alta para pacientes em Unidade de Terapia Intensiva (UTI), que devem ser observados pelos médicos intensivistas. A norma tem como meta contribuir para a melhora do fluxo de acolhimento de pacientes em situação de instabilidade clínica, frente a oferta insuficiente de leitos de UTI, especialmente na rede pública, e a má distribuições das unidades em todo o Brasil.
Com a publicação da Resolução CFM nº 2.156/2016, elaborada pelos membros da Câmara Técnica de Medicina Intensiva do CFM e com contribuições da Associação de Medicina Intensiva Brasileira (AMIB), o Conselho Federal oferece aos médicos parâmetros baseados em critérios clínicos, científicos e éticos para que os profissionais possam lidar com o desafio cotidiano de oferecer o melhor atendimento à população. Segundo a norma, as admissões em UTI deverão levar em consideração os seguintes aspectos: diagnóstico e necessidades do paciente; priorização com base em evidências clínicas; serviços médicos disponíveis na instituição; disponibilidade de leitos; e potencial benefício para o paciente com as intervenções terapêuticas e prognóstico.

Portaria CFM 2156/2016 

URGÊNCIAS E EMERGÊNCIAS EM SAÚDE: PERSPECTIVAS DE PROFISSIONAIS E USUÁRIOS

O importante e instigante livro da antropóloga Armelle Giglio-Jacquemot, problematiza as noções de urgência e emergência em saúde a partir das perspectivas e dos usos que delas fazem os profissionais e os usuários da rede pública de saúde. Por meio de uma pesquisa etnográfica, realizada no período de setembro de 1997 a janeiro de 1999 na Cidade de Marília, São Paulo, Brasil, elege como campo de análise um Hospital Universitário ­ Pronto Socorro do Hospital das Clínicas ­ e a central de chamadas com sistema móvel 192, focando os modos como são realizadas as triagens das urgências e emergências pelos diferentes atores deste processo, desde o vigilante, porteiro, recepcionista, atendente das centrais, motoristas até a equipe de saúde propriamente dita e os usuários.

http://www.scielo.br/scielo.php?pid=S0102-311X2006000300024&script=sci_arttext

Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals

Although you, as a hospital or department leader, are responsible for overseeing performance across a number of dimensions, there are several reasons why addressing emergency department (ED) crowding should be at the forefront of your organization’s improvement efforts: 1. ED crowding compromises care quality. 2. ED crowding is costly. 3. Hospitals will soon report ED crowding measures to the Centers for Medicare & Medicaid Services (CMS). 4. ED crowding compromises community trust. 5. ED crowding can be mitigated by improving patient flow throughout the hospital. The purpose of this guide is to present step-by-step instructions for planning and implementing patient flow improvement strategies.


http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/ptflow/ptflowguide.pdf

FLUXO DE PACIENTES: RECURSOS

Esta página web vai destacar recursos (artigos, relatórios, estudos de caso, etc.) que podem fornecer informações úteis para os hospitais que se preparam para implementar mudanças operacionais, culturais e de gerenciamento de dados para melhorar o fluxo de pacientes em suas organizações.

This web page will highlight resources (articles, reports, case studies, etc.) that can provide helpful information to hospitals as they prepare to implement operational, cultural, and data management changes to improve patient flow in their organizations.

http://www.jointcommission.org/accreditation/patient_flow_resources_.aspx