Jul 17 2012

The Joint Commission Approves Standards Revisions Addressing Patient Flow, Boarding, Behavioral Health Emergencies

Recently, the Joint Commission (TJC) approved standards revisions to address patient flow through the emergency department (ED) and safe provision of care for boarded patients. The revised standards will appear in the 2012 Update 2 to the Comprehensive Accreditation Manual for Hospitals, which is scheduled for publication in fall 2012.

Patient Flow

Leadership Standard LD.04.03.11, known as the “the patient flow standard” addresses how leadership uses data and measurements to identify, mitigate, and manage issues affecting patient flow through the hospital. Despite recent efforts to improve efficiencies, TJC noted that problems with ED patient flow pose a persistent systemic risk to the safety and quality of patient care. Effective January 1, 2013, the revised standard requires hospitals to measure, set, and review results, and take correction action for goals regarding:

  • available supply of patient beds;

  • throughput of areas where patients receive care (e.g., inpatient units, laboratory, operating rooms, telemetry, radiology and post-anesthesia care unit);

  • safety of areas where patients receive care;

  • efficiency of nonclinical services that support patient care; and

  • access to support services (such as case management and social work).


Beginning January 1, 2014, hospitals must measure and set goals for mitigating and managing the boarding of patients (i.e., the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made) who come through the ED. The boarding revisions highlight the safety risk in boarding that may lead to delays in care, compromised outcomes, and excessive demands on staff. TJC recommends that board time frames not exceed 4 hours.

TJC standards also address boarding behavioral health emergencies, including environment of care, staffing, and assessment, reassessment and care provided to the patients.  Effective January 1, 2013, if a patient is boarded while awaiting care for emotional illness and/or the effects of alcoholism or substance abuse, hospitals must:

  • Provide a safe, monitored location for the patient that is clear of items that the patient could use to harm himself or others;

  • Provide training and orientation to any clinical and nonclinical staff caring for such patients in the effective and safe care, treatment, and services for these patients (medication protocols, de-escalation techniques); and

  • Conduct assessments and reassessments and provide care consistent with the patient’s identified needs.

The revised standards aim to promote collaboration with hospital leadership and behavioral health providers and authorities to foster appropriate care coordination for behavioral health patients.

Thank you to Brittany Finlayson, Summer Associate, for her help in preparing this blog post.