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Monday 3:13 CST, December 22, 2014


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May 15, 2013

Clarification: The “patient flow standard” and the 4-hour recommendation


In September 2012, The Joint Commission published revisions to Leadership (LD) standard LD.04.03.11, known as the “patient flow standard,” in the 2012 Update 2 to the Comprehensive Accreditation Manual for Hospitals (see July 2012 Perspectives). Since the publication of this revised standard, organizations have asked The Joint Commission about the source of the 4-hour time frame for boarding recommended in the note at element of performance (EP) 6, which goes into effect January 1, 2014:

Note: Boarding is the practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made. The hospital should set its goals with attention to patient acuity and best practice; it is recommended that boarding time frames not exceed 4 hours in the interest of patient safety and quality of care.

The Joint Commission recognizes that specific boarding time frames will vary from one organization to the next; for this reason, the 4-hour time frame referenced in the note serves as a guideline to help the hospital set a reasonable goal for its institution. Notes are used to provide additional or clarifying information about a specific EP. They are not scored. The 4-hour time frame is not a requirement for Joint Commission accreditation; this stance has been affirmed by Joint Commission legal counsel and extensively reported through official communications to accredited organizations and to Joint Commission field staff. It is not a requirement because The Joint Commission recognizes that meeting such a time frame is not, in some cases, within the control of the accredited organization. The Joint Commission will monitor feedback and provide information to the field to support implementation of the enhanced patient flow requirements throughout 2013. See June 2013 Perspectives for more information, including references from The Joint Commission’s literature search on this subject, results of the field review conducted on potential revisions to the standard, and information about the supporting role of EP 9 for boarding due to behavioral health emergencies. (Contact: Lynne Bergero,



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