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Hospitals throughout the United States and in foreign countries as well have been experiencing frequent periods when they are unable to provide timely care to those seeking services through hospital emergency departments (ED). Patients with serious illness or injury are diverted to other hospitals and when they are able to gain entrance often experience long waits and delays in receiving care. The consequences of the inability to provide timely care to patients seeking care through the ED have not been adequately quantified but are undoubtedly substantial. Massachusetts hospitals have been plagued with ED overcrowding and its consequences for over five years. It was MVP faculty, supported by a grant from the Massachusetts Department of Public Health, which carried out the research that theoretically and empirically established the link between ED overcrowding, the lack of inpatient capacity and the critical role of variability as the causal factor. Those findings were reaffirmed in further studies by MVP faculty at Children’s Hospital in Boston that identified artificial variability in demand as the cause of the high rejection rate of patients seeking inpatient services. The work and research of the MVP have been instrumental in demonstrating to policy makers and health care leaders in Massachusetts and elsewhere the importance of optimizing patient flow in addressing the problems of ED overcrowding and its consequences of ambulance diversion and patient boarding. Recognizing this incontrovertible link, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has issued a new standard that goes into effect on Jan 1, 2005 that directs hospitals to manage patient flow in order to address ED overcrowding and consequent problems. In commenting on hospitals’ ability and need to comply with the new standard in the context of a newspaper report on the success achieved at Boston Medical Center in reducing diversion through smoothing variability, Dr. Dennis O’Leary, President of JCAHO, stated, “[A]nybody who comes to me and says, ‘I can’t do this’, I’m going to send them to Boston Medical Center." |
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