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Joint Commission Official: Don't Put Patients in Egress Halls When ED Overcrowds
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.
Scott Wallask is senior managing editor for the Hospital Safety Center. He can be reached at swallask@hcpro.com.
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Peggy Desiderio (7/1/2009 at 1:32 PM)
I cannot believe JCAHO response to ED overcrowding. When there is no feasible way to flow pts there has to be the responsibility of the floor nurses to kick in.... is it safer for patients to sit in an overcrowded ED where the nurses have patient loads that are unimaginable on floors, a variety of patients with variety of medical needs as well the continuing influx of patients and their needs? so much has been said and fought for safe staffing ratios yet the ED is untouched by these ratios. Nurses are to be patient advocates, maybe I am naive but I thought that meant all nurses. In my facility, the manager has worked with increased staffing and tried to assist in all areas of pt traffic but there is the fact of actual area constraints. The walls do not stretch and the common complaint of ED nurses is the floor nurses NOT taking patients. The ENA should assist JCAHO in advocating for the patients. As a patient or family member of a patient would you prefer your family member in an overcrowded area (many times the ED hallway) as opposed to the less crowded floor hallway as well as under the care of a less overloaded RN?