HOSPITAL STATUS PROGRAM
 

 

 

 

 

 

 

 


Emergency Health Services Federation, Inc.

722 Limekiln Road · New Cumberland, PA  17070-2354

717-774-7911 · 1-800-334-EHSF · 717-774-6163 fax


web page · www.ehsf.org

 

 


TABLE OF CONTENTS

 

 

I.          INTRODUCTION                                                        3

 

II.         BACKGROUND                                                          4

 

III.       DEFINITIONS                                                             5

 

IV.       HOSPITAL STATUS WEB PAGE

 

            1. Viewing the Web Page                                              6

            2. Using the Web Page                                                  8

            3. Menu Functions                                                         8

 

V.        PREHOSPITAL

 

            1. Awareness                                                                10

            2. Destination Planning                                                  11

            3. Documentation                                                          12

 

VI.       HOSPITAL 

 

            1. Thresholds                                                                13

            2. In-house Planning and Procedures                              13

 

VII.      COMMUNICATIONS

 

            1. Emergency Communications Center                           16

            2. Destination Planning                                                  16

 

VIII.     STRATEGIES FOR AREA-WIDE OVERLOADS

 

            1. Definitions                                                                 17

            2. Special Consideration for Trauma Centers                   17

 

IX.       CONTINGENCY PLAN                                              18

           

 

 

I.                   Introduction

 

 

Emergency medical services are an integral part of the health care system.  As such, problems encountered by ambulance services may effect the quality of patient care.

 

Problems, which cannot be resolved by the ambulance service or which impact on many ambulance services, are routinely presented to the Emergency Health Services Federation or the Pennsylvania Department of Health for assistance and answers.

 

The concern of hospital diversions and emergency department closings has grown due to an increase in the number of such incidents.  These concerns have been identified with numerous contributing factors that have an effect on the emergency medical system, which includes both prehospital and hospital concerns.

 

Ambulance services must deal with a variety of issues to assure quality prehospital patient care.  Many of these issues are beyond their control, so innovative management is a must.  It is assured that prehospital personnel will endeavor to improve the system when patient care is compromised.

 

Ambulance services, already facing shortages of volunteers, increased operational costs, and demands of quality patient care, must now deal with diverts and emergency departments not accepting patients.  These additional problems potentially necessitate time delays; increases in time spent treating unstable patients, additional transport times to distant receiving facilities, and longer times being unavailable for calls in their primary response area.  Neighboring EMS services must assist with EMS coverage as a backup for an ambulance service involved with transporting patients during a divert situation.  All of these place demands on an EMS system already burdened by other factors.

 

Hospitals, on the other hand, must deal with their own unique set of concerns.  The development of intensive manpower shortages (particularly in nursing), increasing admissions in general, and increasingly severe patient admissions has forced the hospitals in this region to frequently close their doors to ambulances.  Diversion is a logical solution to a temporary shortage of health care resources, but it also raises a number of issues.  For example, patients who are diverted to another hospital may not be treated by their regular physician if the physician does not have privileges at the other facility.  Hospitals sometimes fail to notify those concerned when they are no longer on divert and therefore, end up continuing a diversion longer than necessary.   Also, due to operational differences, each hospital has a different threshold that triggers a diversion.  One facility may go on divert when its occupancy rate reaches 95 percent, while another facility may wait until the number of patients being held in its emergency department reach an unmanageable number before it calls for a diversion.  Finally, when all area hospitals go on divert, patients may be forced to travel long distances for emergency health care or go to a hospital that is already overwhelmed with patients.

 

This program is intended to improve communications among hospitals, EMS services and communication centers.  There are sections to assist hospitals in developing policies that encourage efficient use of resources and minimize the need for diversions and guidance for EMS services when dealing with a divert status. 


 

II.        BACKGROUND

 

In 1990, the Emergency Health Services Federation developed the Hospital Bypass and Diversion Guidelines.  Since that time, an increase in the number of diversions has necessitated a review of the guidelines to determine the current effectiveness. 

 

This review identified several areas in need of improvement: definitions, communications and education.  There was a consensus that the definitions were confusing to hospitals, communication centers and EMS personnel.  The term “bypass” and “divert” were being used interchangeably which created confusion.  There was little understanding of the difference between the two terms.  The EHSF Medical Advisory Committee felt the term “bypass” for only the Emergency Department was not effective.  A review of the American College of Emergency Physicians policy statement prompted the decision to use the common term divert with the specific identifier for the hospital specialty area. 

 

The communication of a diversion status was often made by personnel unfamiliar with the terminology.  This communication was made to various hospital and communication centers.  If the same personnel made the calls, some consistency may have occurred.  However, if different personnel made calls, some slight differences in reporting could create confusion.  The information was “posted” for the duration of the diversion, and removed upon completion or notice of a change in status.  Minimal records were kept of the diversion status, the duration or the frequency of occurrence.

 

Although the guidelines were distributed to all hospitals, EMS services and communication centers, the understanding of the definitions is limited.  The turnover in personnel could also contribute to the lack of understanding of the definitions or policies.  The revised Hospital Status Program will provide an educational opportunity for all personnel.  Hospital personnel will require education on the method to assign a divert status for their hospital.  Prehospital personnel need to understand the meaning of the divert status which may necessitate a change in their prehospital operational policies.  Communication centers will need to understand the importance of notifying the EMS personnel of a divert status early in the emergency response.  Early notification will assist in patient care and destination decisions. 

 

The revised Hospital Status Program is based on the technology made available by the Internet.  A Hospital Status Web Page will provide easy access for hospital personnel to make changes that can quickly and easily be disseminated to a variety of agencies and organizations.  A major component of the Hospital Status Web Page will be a database that will collect all information related to a divert status.  This data can be analyzed to monitor trends, provide support documentation for improvements and evaluate the effectiveness of the Program. 

 

The Hospital Status Web Page will be displayed 24 hours a day, 7 days a week at all regional communication centers.  The automated five (5) minute updates of the Web Page will provide for minimal time lapse for divert status changes.  The Hospital Status Web Page can also be viewed by anyone with Internet access. 

 

The Hospital Status Program will be monitored for the effectiveness of the Program.  The EHSF Medical Advisory Committee will be given reports on the Program.


 

III.             DEFINITIONS                      

 

Critical Care Divert: the hospital’s intensive care resources are fully committed and are not available for additional patients requiring intensive care.  It will be assumed that a “Critical Care Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

CT/Neurological Divert: the hospital’s CT capability and/or neurological resources are fully committed and are not available for additional patients requiring a CT or neurological care.  It will be assumed that a “CT/Neurological Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

ED Divert: applies strictly to the hospital emergency department.  It indicates that the emergency department cannot accept any additional patients transported by ambulance. It will be assumed that an “ED Divert” designation automatically terminates TWO hours after it is initiated, unless it is renewed.  “ED Divert” does not prohibit ambulances from transporting direct admission patients to the facility.  Trauma Center patients are not included in this Divert Status.

 

General Medical Divert: the hospital’s medical resources are fully committed and are not available for additional patients requiring medical admissions.  It will be assumed that a “General Medical  Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

General Surgery Divert:  the hospital’s general surgery resources are fully committed, and are not available for additional patients requiring general surgery.  It will be assumed that a “General Surgery Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

OB/GYN Divert:  the hospital’s OB/GYN resources are fully committed, and are not available for patients requiring OB/GYN care.   It will be assumed that an “OB/GYN Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

Pediatrics Divert:  the hospital’s pediatric resources are fully committed and are not available for additional pediatric patients requiring care.  It will be assumed that a  “Pediatrics Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

Psychiatric Unit Divert: the hospital’s psychiatric resources are fully committed and are not available for additional psychiatric patients requiring care.  It will be assumed that a  “Psychiatric Unit Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

Total Divert:  no inpatient beds of any kind are available.  Emergency Department patients may require transport to another hospital for admission.  It will be assumed that a  “Total Divert” designation automatically terminates eight hours after it is initiated, unless it is renewed.

 

Trauma Divert -  applies to the regional trauma centers (Hershey Medical Center - Penn State Geisinger Health Systems, York Hospital, Lancaster General Hospital) only:  When trauma resources are fully committed, and the facility cannot accept additional seriously injured patients because the trauma team is encumbered with trauma patients in the ED, OR, or CT.   It will be assumed that a  “Trauma Divert” designation automatically terminates TWO hours after it is initiated, unless it is renewed.

 

 

IV.       HOSPITAL STATUS WEB PAGE

 

1.                   Viewing the Web Page

 

The EHSF Hospital Status web page address is: hospitals.ehsf.org

This address will load the main page which is split into four panes.

 

 

·         TOP PANE:                     

 

a)      EHSF Hospital Status title bar.

b)      Clicking on the EHSF logo in the far-left corner will hyperlink the user to the EHSF home page www.ehsf.org.

c)      The lower portion of the center of the title bar displays the time and date the current view was loaded and updates automatically in five-minute intervals.

d)      The far right corner will hyperlink the user to the home page of the company responsible for design and maintenance of the page.

 

·         BOTTOM PANE

 

Hospital Order

-          Allows the user to choose the order of the first ten receiving facilities to be displayed in the left and right pane. These ten hospitals will populate the first five lines of the pane. The remainder of the hospitals will be populated randomly.

 

Login

-          Opens the Login screen where an authorized user is prompted to enter a user name and password. This option will change the appearance of the bottom pane displaying a menu corresponding to the user’s level of access.

 

·         LEFT and RIGHT PANES:

 

Headings

-          Displays the headings: Hospitals, Status, and Expiration of Current Status. If no selection is made from the drop down menu in the left pane, the page will display the four divisions alphabetically by default.

-          Hospitals accepting patients in all departments will display a status of OPEN.  ED and CT/NEURO diversions will display the affected unit in Bold Red letters.

-          All other diversions will be displayed in Bold Dark Blue

-          A bold red divert which is flashing indicates a new divert that has activated within the previous ten minutes.(Netscape Navigator users only)

-          A maximum of three simultaneous divert statuses may display for each facility.

-          Facilities displaying divert statuses will also display the time and date of each divert expiration.  ED divert is limited to two (2) hours and unit diverts are limited to eight (8) hours.  Unless renewed, a divert will expire in real time and update the hospital status as OPEN.

 

Trauma Centers

-          A GREEN lettered trauma center indicates an OPEN status.

-          A RED lettered trauma center indicates a TRAUMA DIVERT status.

 

 

 

2.                   Using the Web Page

 

Anyone with Internet access may view the Hospital Status web page.  However, using the web page is restricted to authorized individuals assigned one of three levels of access rights.  These levels are defined as users, managers and administrators.

 

·                 USER

 

A user is an individual who has been assigned access rights to change or update the divert status of a hospital unit(s).  User level login allows access to the unit selection drop down menu where a change of status is made. User level access is restricted to their hospital assignment. 

 

·         MANAGER

 

Managers are typically supervisors or unit managers.  These individuals have the ability to assign users for the hospital(s) under their direction.  A manager login allows access to the editing of users menu and the divert log reporting system as well as the change of status menu.

 

·                 ADMINISTRATOR

 

The Administrators are assigned by EHS Federation to monitor and maintain the Hospital Status web page.  The administrator login allows access to the database management tools as well as the user and manager menus.  A key function of the administrator is database management.  Hospitals who wish to add, delete or troubleshoot manager passwords must contact the administrator.  The EHSF will serve as the contact point for providers, hospital personnel and regional communications centers to address comments and questions.

 

3.                   Menu Functions

 

·                 LOGIN

 

Clicking on Login will open the log on screen prompting the user to enter a user name and password. Entries are not case sensitive but will deny user access for incorrect or misspelled entries.  After logging on, the page will revert to the main screen displaying the menu corresponding to the user’s level of access.

 

 

·                 LOGOUT

 

Clicking on Logout will end the user’s current session.  Users who initiate a session on a terminal that continuously displays the Hospital Status web page must log out of each active session to prevent potential errors and unauthorized access.

 

·         CHANGE STATUS

 

Clicking on Change Status from the main menu will open the status selection menu for the hospital the user is assigned.  Contained within the status menu is a drop down menu of hospital units available for status change.  This is a preset list of unit names that cannot be changed to suit unique naming structures in place at individual facilities.

 

-      “Make status stop any current diverts” is the default divert status bullet.  Selecting a unit divert and clicking OK with this bullet will override any current divert status displayed for that facility.  Selecting a unit for divert and clicking OK brings the user back to the main screen where the divert status will display in bold red next to that facility.  The status will flash for ten minutes to indicate a new divert.

-      “Add this status to current diverts” needs to be selected to add an additional unit to a facility currently listing of a divert status.  Make this selection before clicking OK.  A maximum of three diverts may be displayed per facility.  The divert selection menu does not allow for multiple unit selections.  Therefore, each divert status must be entered and accepted individually.

 

** If the divert status does not display immediately upon returning to the main screen, you can refresh the web-browser to verify the change or it will also appear after the automatic five minute status update has occurred.

 

·         EDIT USER

 

This selection allows managers to add and delete users and change user passwords when necessary. Clicking on Edit User will display the list of authorized users.  To add a user, click Add at the top of the list. A new user entry box will display.  The manager will first enter the user’s name.  Users should be identified by their actual name, not by methods such as an employee ID number.  The manager will assign a user password then confirm the password. The entry will be rejected if any of the required fields are left blank or the password and confirmation do not match.

 

To delete a user, open Edit User from the main menu.  Locate the individual in the list of users and click the Delete next to that user’s name.