In an effort to amplify the voice of our members, ACEP met earlier this year with several leaders of The Joint Commission, focusing much of the discussion on the pervasive problem of boarding patients in emergency departments.

ACEP President-Elect Dr. Angela Gardner, Executive Director Dean Wilkerson, and I met on Jan. 22 with Dr. Mark Chassin, TJC president, and his senior staff, Charles Mowll (executive vice president, business development, government and external relations), Dr. Paul Schyve (senior vice president), and Dr. Robert Wise (vice president, division of standards & survey methods).

The senior TJC staff seemed to understand the boarding issue, including how it impacts quality and patient safety and how we believe boarding to be the number one concern for our health care system. The TJC staff said they have worked for years under the premise that ED boarding is a hospital-wide system issue, and expressed frustration about their difficulty to document ED boarding.

Even though TJC surveys are unannounced, they explained, surveyors report they rarely encounter patients boarding in the ED hallway. Of course, both ACEP and TJC leaders know it is prevalent in hospitals across the country, and we discussed possible solutions to this sampling error.

We presented TJC with ACEP’s Boarding Solutions Task Force Report. They were impressed that our report was disseminated by the American Hospital Association, a sponsoring organization of TJC. The TJC has agreed to provide a link from their Web site to ACEP’s boarding report. We discussed other possible solutions, including having TJC require their surveyors to have a standard for ED patient throughput and provide their surveyors some of the best practices to prevent boarding.

Dr. Chassin told us that they have a process to receive complaints from physicians or the public, including a process that allows for anonymous complaints. This can be done by sending an e-mail message to complaint@jointcommission.org, by calling the TJC report hotline at 800-994-6610, or by sending a written complaint by fax to the Office of Quality Monitoring at 630-792-5636 or by mail to Office of Quality Monitoring, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181.

Dr. Chassin said the TJC receives almost 1,000 complaints each year, and that several hundred are investigated. Many are related to delays in ED care, which he believes may have boarding as a potential cause.

In the remaining discussion, we informed TJC’s leadership about the many initiatives ACEP has in the quality arena, including development of quality measures through the AMA Physicians Consortium and the National Quality Forum. We discussed various opportunities in which Dr. Chassin (or other TJC representatives) might appear at ACEP events, make presentations, answer questions, and engage in dialogue with ACEP members. We will invite Dr. Chassin to meet our members at our Leadership and Advocacy Conference this April.

We also discussed our mutual successes on issues such as allowing ED triage nurses to initiate approved protocols prior to physician evaluation and eliminating the requirement that a pharmacist prospectively review first-dose ED medications.

We are hopeful we can expand our involvement with TJC through their Physician Advisory Group and perhaps their Board of Commissioners.