ADMINISTRATIVE POLICIES & PROCEDURES

MANUAL CODE: TX:0052
RE-REVIEW DATE: (Assigned by Policy Review Committee)
SUBJECT:
Emergency Department Full Capacity Protocol

Responsible Department, Division, or Committee: Medical Director’s Office
Effective Date Original Policy: ________________________
Effective Date Revised Policy: 02/22/2001
Supersedes Policy Number: _______________
Last Review Date: ______________ Dated: ______________

SUBJECT: Emergency Department (ED) Full Capacity Protocol (In-House Hall Bed Placement)

SCOPE: ED, Admitting Department, Physicians, Nursing Department, Administrative Personnel, Acute Care Units as listed: 19 North, 19 South, 16 South, 15 North, 15 South, MRN, 5L Ortho, 5L Cardiac (ICRs are excluded).

PURPOSE: To facilitate the admission of adult patients held in the ED awaiting Acute Unit Bed Assignment.

POLICY: When an adult patient requires admission to an Acute Care Unit from the ED and that area cannot accommodate that patient because of lack of sufficient beds, the patient will be admitted to the next most appropriate bed. In the event appropriate hospital bed utilization has been maximized, and the number of admitted patients holding in the ED has prohibited the evaluation and treatment of incoming patients to the ED in a timely fashion, the admitted ED patients already awaiting in-house acute care bed assignments will be admitted to acute care unit hall beds.

The Bed Utilization Coordinator will facilitate this policy. When unavailable during the day, the ADN on call to the Nursing Staffing Office in collaboration with the Staffing Coordinator will assume responsibility and assign hall beds in conjunction with the Bed Control Supervisor. On nights and weekends, the ADN on duty shall serve this role.

The placement of patients to hall beds will be implemented by the Bed Utilization Coordinator only after the ED Attending Physician, the Charge Nurse, and the Bed Utilization Coordinator have declared the need to implement the ED Full Capacity Protocol and approval to do so has been granted by the Medical Director of University Hospital, the Chief Operating Officer, or the Chief Executive Officer, or their designees. The decision of patient placement by the Bed Utilization Coordinator after discussion with the ED Attending physician (if indicated) shall be binding.

If hall bed placement has been maximized (two per unit) and the ED is still at Full Capacity, the Chief Executive Officer, Chief Operating Officer, and the Medical Director will be notified and make decisions on implementation regarding deferral of elective and urgent cases and ED Diversion.

FORMS: None

POLICY CROSS-REFERENCES: Commissioner of Health Memo on ED Overcrowding dated Dec. 11, 2000.

DEFINITIONS: ED Full Capacity Protocol identifies "full capacity" when 100% of the main department is occupied with patients and admitted (ED) patients have been awaiting in-house placement for two hours.

ALL UNOCCUPIED ACUTE FLOOR BEDS SHOULD BE UTILIZED BEFORE HALL BEDS ARE USED, WHERE NURSE COMPETENCY PERMITS SUCH PLACEMENT.

A. Patient Priorities for Hall Bed Placement:

1. Nontelemetry patients with little or no comorbidity will be first considered for hall bed placement.

2. Nontelemetry patients with minimal to moderate risk factor comorbidity will be the second patient population to be considered for hall beds

3. Patients admitted on or for telemetry monitoring with little or no comorbidity and with minimal index of suspicion for a cardiac event will be the last patient population to be considered for hall bed placement.

4. For adults ages 18, 19, and 20, they can be considered for a Pediatric Unit if a bed is available.

Telemetry patients will be assigned to hall beds only after approval of the ED Attending Physician and it has been confirmed that the receiving in-house unit has a telemetry box and a central monitoring slot. Telemetry C patients in the ED may be assigned to 16S or non-16S hall beds except that arrhythmia patients and patients who already have ruled-in for MI may not go to 5L.

B. Exceptions:

1. Patients on Acute Units will not be moved to hall beds in order to make room for patients admitted from the ED.

2. Patients being transferred out of Intermediate Care or the Intensive Care Unit (ICU) beds will not be placed in hall beds.

3. If hall bed utilization has been maximized and the ICU is full, and there is one or more ICU patients waiting in the ED, the next available floor bed will go to an ICU patient transferring out of ICU (not to a hall bed patient).

4. Any "exception" to the above will be with the individual approval of the Medical Director or designee.

PROCEDURE

A. Hall Patient Placement During Weekday Shift:

1. The ED Attending Physician, Charge Nurse, and the Bed Utilization Coordinator will declare full capacity.

2. The Bed Utilization Coordinator will request approval to implement the ED Full Capacity Protocol from the Chief Executive Officer, the Chief Operating Officer, or the Medical Director.

3. Once approval is granted, the Bed Utilization Coordinator will notify the Directors of Patient Care of the need to implement the ED Full Capacity Protocol.

4. Nursing Staffing Office will notify the respective units that the ED Full Capacity Protocol is in effect and of the need to prepare for hall bed patients.

5. Patients admitted to hallways on inpatient units will be placed as much as possible according to service. Each unit will receive one hall bed patient. After all applicable units have received one patient, a second hall patient may be assigned. No unit will have more than two hall bed patients.

6. Patients admitted to hallways on inpatient units will be prioritized over the ED for admission to the first available bed on any unit where nursing competencies meet patient needs. Hallway patients need not be admitted to the unit on which they are boarding.

B. Procedure on the Off-shifts:

1. The ED Attending Physician and Charge Nurse will notify the ADN on duty that ED Full Capacity is being invoked.

2. The ADN will request approval to implement the ED Full Capacity Protocol from the Chief Executive Officer, the Chief Operating Officer, or the Medical Director.

3. The Nursing Staff Office will notify all Medical, Surgical, and Cardiac Units that the ED is on Full Capacity Protocol and to expect hall bed patients.

4. The ADN will notify the Bed Control Supervisor to begin placing hall bed patients on the designated acute floors and will intervene for any placement.

C. Hall Bed Exclusions:

Admitted ED patients that will not be placed in hall beds:

1. Patient requiring the Intermediate Care Unit or the ICU will not be placed in hall beds.

2. Vented patients will not be placed in hall beds.

3. Patients requiring isolation or negative pressure room placement will not be placed in hall beds.

4. Patients requiring minimal oxygen (less than 4 L via nasal cannula) will arrive to the unit hall bed assigned with a full tank of O2. (Any equipment exchange will be prearranged prior to transporting the patient.)

5. Patients who require suctioning are poor candidates for hall bed placement.

D. Procedure for Discontinuation:

1. All unit hall bed placements have been maximized (two per unit).

2. The ED no longer needs hall bed placements.

3. ED Attending, Charge Nurse, and Bed Utilization Coordinator agree to stand down from the Protocol.

4. The Bed Utilization Coordinator/designee will notify the Nursing Staffing Office. The Nursing Staffing Office will notify all units.

Source: Stony Brook (NY) University Hospital & Medical Center.