Those of you who plan to move patients into exit corridors when routine ED overcrowding occurs may want to reconsider that policy 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, said George Mills, FASHE, CEM, CHFM, senior engineer at The Joint Commission.
Even if state regulators order healthcare facilities to get patients out of EDs and instead hold them in inpatient unit corridors, The Joint Commission doesn't believe this is the best approach, Mills said during a recent Joint Commission Resources audio conference.
Instead, such a situation should prompt facility managers and ED directors to review ED traffic flow and come up with better ways to manage overcrowding, he said.
An exception to this stance 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 a sudden surge of victims.
An exception: Disaster influxes
The Joint Commission's position has wider backing. The Healthcare Interpretations Task Force—an influential group of authorities that reviews National Fire Protection Association (NFPA) provisions for medical settings—developed an informal policy on the matter that frowns upon staging patients in egress corridors.
The task force's decisions aren't formal NFPA interpretations and don't change any the language of standards or codes. However, the task force's members agree to abide by the group's decisions to the extent practical.
An important point: The task force indicated the policy doesn't apply to ED surges caused by disasters that resulted in a large influx of victims to a facility.
The thinking is that such events are hard to fully plan for and the immediate need of medical services may temporarily trump exit corridor requirements in the Life Safety Code.
Hospital moves with state approval
The Joint Commission's stance comes as a surprise to Dennis Irish, spokesperson for Saint Vincent Hospital in Worcester, MA, especially given that the Massachusetts Department of Health and the state fire marshal have communicated about how patient boarding in hallways can work within fire safety requirements. The Department of Health ruled in January 2009 that hospitals in Massachusetts can't divert ambulances to other healthcare facilities to avoid ED overcrowding.
Saint Vincent's policy is to put boarded patients in wheeled chairs—not gurneys—in the hallways on rare occasions when the ED is in danger of being overpopulated, Irish said.
"It's a last resort," he added.
In a letter to local fire chiefs posted online, the Massachusetts fire marshal highlighted the Department of Health's new overcrowding policy. The letter further asked chiefs to work closely with hospitals in their communities to understand healthcare egress strategies in the event that patients are boarded in corridors.