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

RESOLUÇÃO CFM nº 2.077/14

Dispõe sobre a normatização do funcionamento dos Serviços Hospitalares de Urgência e Emergência, bem como do dimensionamento da equipe médica e do sistema de trabalho.


www.portalmedico.org.br

Overcrowding Crisis in Our Nation’s Emergency Departments: Is Our Safety Net Unraveling?

http://www.pediatricreadiness.org/files/PDF/Library/Overcrowding_Crisis_in_Our_Nations_EDs-Is_Our_Safety_Net_Unraveling.pdf

ABSTRACT. Emergency departments (EDs) are a vital
component in our health care safety net, available 24
hours a day, 7 days a week, for all who require care.
There has been a steady increase in the volume and
acuity of patient visits to EDs, now with well over 100
million Americans (30 million children) receiving emergency
care annually. This rise in ED utilization has effectively
saturated the capacity of EDs and emergency
medical services in many communities. The resulting
phenomenon, commonly referred to as ED overcrowding,
now threatens access to emergency services for those who
need them the most. As managers of the pediatric medical
home and advocates for children and optimal pediatric
health care, there is a very important role for pediatricians
and the American Academy of Pediatrics in
guiding health policy decision-makers toward effective
solutions that promote the medical home and timely
access to emergency care. Pediatrics 2004;114:878–888; access
to emergency care, ambulance diversion, emergency
medical services for children, EMTALA, emergency department
overcrowding.

The Crisis in America's Emergency Rooms and What Can Be Done

http://www.heritage.org/research/reports/2007/12/the-crisis-in-americas-emergency-rooms-and-what-can-be-done

America's emergency rooms are in crisis.
Emergency medicine encompasses the care of patients with traumatic injuries or serious signs and symptoms of disease. Quick evaluation and rapid treatment of these patients obviously cannot be done on an "elective" basis. These services are invariably provided under the auspices of a hospital and are available to patients 24 hours a day, seven days a week.

HOW ED CROWDING AFFECTS OUTCOMES

http://www.physiciansweekly.com/emergency-department-crowding-outcomes/

Previous studies have sought to establish a definitive relationship between ED crowding and subsequent mortality, but these investigations often have shortcomings, such as small hospital samples and a lack of adjustment for comorbidities, primary illness diagnoses, and potential hospital-level confounders. In addition, many of these analyses restrict data to specific subgroups, such as patients with acute myocardial infarction, trauma, pneumonia, or critical illness. - See more at: http://www.physiciansweekly.com/emergency-department-crowding-outcomes/#sthash.BNLK6nbn.dpuf

Previous studies have sought to establish a definitive relationship between ED crowding and subsequent mortality, but these investigations often have shortcomings, such as small hospital samples and a lack of adjustment for comorbidities, primary illness diagnoses, and potential hospital-level confounders. In addition, many of these analyses restrict data to specific subgroups, such as patients with acute myocardial infarction, trauma, pneumonia, or critical illness. - See more at: http://www.physiciansweekly.com/emergency-department-crowding-outcomes/#sthash.BNLK6nbn.dpuf

Previous studies have sought to establish a definitive relationship between ED crowding and subsequent mortality, but these investigations often have shortcomings, such as small hospital samples and a lack of adjustment for comorbidities, primary illness diagnoses, and potential hospital-level confounders. In addition, many of these analyses restrict data to specific subgroups, such as patients with acute myocardial infarction, trauma, pneumonia, or critical illness. - See more at: http://www.physiciansweekly.com/emergency-department-crowding-outcomes/#sthash.BNLK6nbn.dpuf

Improving Patient Flow and Reducing Emergency Department Crowding

 http://www.ahrq.gov/research/findings/final-reports/ptflow/index.html

 

A Guide for Hospitals

This guide presents step-by-step instructions that can be used by hospitals in planning and implementing patient flow improvement strategies to ease emergency department crowding.
By Megan McHugh, PhD, Kevin Van Dyke, MPP, Mark McClelland, MN, RN, Dina Moss, MPA. 

Contents

Acknowledgments
Executive Summary
Section 1. The Need to Address Emergency Department Crowding
Section 2. Forming a Patient Flow Team
Section 3. Measuring Emergency Department Performance
Section 4. Identifying Strategies
Section 5. Preparing to Launch
Section 6. Facilitating Change and Anticipating Challenges
Section 7. Sharing Results
References
Appendix A: Guide to Online Resources Successfully Used by Hospitals to Improve Patient Flow
Appendix B: Implementation Plan Template
Appendix C: Example Implementation Plan
Appendix D: Additional Readings

Superlotação no Pronto Socorro: Urgências e Emergências em Saúde: perspectivas de ...

Superlotação no Pronto Socorro: Urgências e Emergências em Saúde: perspectivas de ...: Urgências e Emergências em Saúde: perspectivas de profissionais e usuários Armelle Giglio-Jacquemot Coleção Antropologia e Saúde ...

Apresentação no slideshare sobre superlotação no departamento de emergência,

http://www.slideshare.net/emomsb/ed-overcrowding

Livro - Desafios da Gestão Estratégica em Serviços de Saúde: Caminhos e Perspectivas - Carlos Alberto Gonçalves e Luciana Faluba DamázioO setor de saúde tem sido foco de atenção nos últimos tempos, em função de seu crescimento e desenvolvimento tecnológico. Além disso, desempenha papel estratégico na sociedade, na medida em que atua na manutenção do equilíbrio social, zelando pelo cuidado do bem-estar e pela sobrevivência das pessoas. Trata-se de um setor complexo, que exige níveis elevados de capacitação, lida com tecnologia de ponta e envolve diversas instituições com interesses distintos. Sua gestão estratégica constitui um dos principais desafios do sistema de saúde no país, mais especificamente dos serviços de saúde. Gerir uma organização altamente complexa, em um ambiente complexo, que acena com mudanças estruturais, tem se mostrado uma questão importante, na medida que a demanda explode e a concorrência se estabelece. Dessa forma, o objetivo deste livro é discutir os principais desafios associados à gestão estratégica em serviços de saúde, diante do contexto anteriormente explicitado, apresentando temas que abrangem um grande espectro de conhecimento para os gestores aplicados nesse campo de trabalho

Urgências e Emergências em Saúde: perspectivas de profissionais e usuários

Armelle Giglio-Jacquemot

Coleção Antropologia e Saúde

A obra pretende desvendar o que seja uma urgência ou uma emergência em saúde a partir de duas perspectivas: a dos usuários e a dos profissionais da rede pública.  A autora mostra um universo dinâmico e complexo a partir de um trabalho antropológico realizado na Faculdade de Medicina de Marília, em São Paulo. São decisões médicas, muitas vezes de suma importância para a manutenção da vida, muitas vezes questionáveis sob o ponto de vista ético. Cabe lembrar que o livro não só trabalha com a dicotomia médico/paciente, mostrando para o leitor outros atores envolvidos no trabalho na emergência e revelando que muitas vezes as ações médicas são antecedidas por pequenos passos e atitudes peculiares de significativa importância que não podem ser desconsiderados, como a de um motorista de ambulância ou o porteiro do hospital.

Hospital Overcrowding - A site dedicated to our patients, their care, and their safety

I am a practicing emergency physician and clinical director of the emergency department at Stony Brook on Long Island.  Our institution believes that the ED is a vital community resource, and must be able to deliver needed services at all times. We do not consider ambulance diversion a responsible option. We also believe that admitted patients are best cared for by health care providers whose specialty is inpatient care, in a quiet and calm place where that care can be best provided. Thus, we use the "Full capacity protocol" (FCP) at Stony Brook, which moves patients upstairs when we're full, allowing us to address high hospital census in a distributive and safe fashion. http://www.hospitalovercrowding.com/

Tratando a superlotação à partir da admissão

ACEPFixing emergency department overcrowding will require new approaches to patient admissions and boarding, according to Dr. Peter A. Viccellio.
In contrast to popular opinion, ED overcrowding is not the result of inappropriate visits by the uninsured, illegal immigrants, or people with minor or exaggerated complaints, he said at the Scientific Assembly of the American College of Emergency Physicians.

CONFERÊNCIA CANADENSE SOBRE SUPERLOTAÇÃO NO PRONTO SOCORRO 2012

Western Emergency Department Overcrowding Conference will be held in Vancouver on April 27 and 28th at the Morris J Wosk Center for Dialogue. http://www.sem-bc.com/News/CME-CPD/Western-Emergency-Department-Overcrowding-Conference-2012-Vancouver-BC

Emergency Medicine Crowding and Boarding

As emergency departments throughout the country deal with the problems of crowding, boarding, and ambulance diversion, solutions have been sought. The resources on this page provide information, resources and examples of a variety of approaches to assist emergency physicians in addressing the crowding problems by working with hospital administrators, local stakeholders, policy makers and the public. Some ACEP chapters have sought relief through state legislative and regulatory action. These additional crowding resources are available in ACEP's Advocacy area.
http://www.acep.org/crowding/