Harbor:Diversion for ALS and BLS: Difference between revisions

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<big>Diversion decisions made by MICN, Overall Charge RN and Area Charge RNs, and Attending huddle q4 hours prn</big>
'''ALS Diversion'''
'''ALS Diversion'''
*ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.  
*ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.  
**ED Saturation does NOT redirect BLS arrivals or patients arriving to Harbor as a specialty center (e.g. Trauma, STEMI, Perinatal).  
**“ALS ED Sat” does NOT redirect BLS arrivals or specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal)..  
*Up to two hours at a time. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to all 9-1-1 traffic.
*ALS ED Sat” lasts for two hours but can be ended earlier. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to ALS.  
*If the nearest two alternative EDs are also noted as “ED Saturation”, ALS ambulances will be directed to the closest ED, regardless of “ED Sat” status on ReddiNet. (everyone is open)
*If the nearest alternative ED is also noted as “ALS ED Sat”, ALS ambulances will be directed to the closest ED, regardless of “ED Sat” status on ReddiNet.  
*'''Goal''' of ED Saturation is to ensure safety of current ED patients and of patients being transported by EMS. Diversion facilitates this by:
*“ALS ED Sat” is not a command, but a suggestion. EMS can still bring the patient to the MAR if it is considered to be the safest decision (e.g. patients in extremis)  
**Allowing staff the time to move patients within or through the ED to free up space/staff resources to care for additional patients, without pressure of incoming patients.  
*'''Goal''' of Diversion is to ensure safety of current ED patients and of patients being transported by EMS by::
**Allowing staff time to move patients within or through the ED to free up space/staff resources.  
**Allowing the ED time to prepare for next round of sick patients.
**Allowing the ED time to prepare for next round of sick patients.


'''Guidelines for ALS Diversion triggers''':  
'''Guidelines for ALS Diversion triggers''':  
*Not enough space to care for the next critical patient coming by ambulance
*Consider when not enough space to care for the next critical patient coming by ambulance
**Not enough treatment spaces despite decompress patients to other beds/hallway
**Not enough treatment spaces despite decompress patients to other beds/hallway
**Not enough staff (RN, RT, provider, etc.) or supplies (vents, blood, etc.)
**Not enough staff (RN, RT, provider, etc.) or supplies (vents, blood, etc.)
*Diversion decisions made by joint agreement of MICN, OCN, AED Charge, and Attending
*OCN & Attending names are recorded in the ReddiNet as the Authorizing personnel
'''BLS Diversion'''
*“BLS ED Sat” is added to ALS ED Sat and marks the ED in the countywide ReddiNet system as “closed” to all ALS and BLS arrivals.
*“BLS ED Sat” does NOT redirect specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).
*Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.
*Requires hospital administration approval




'''Guidelines for BLS Diversion triggers''': Requires hospital administration approval
'''Guidelines for BLS Diversion triggers''': Requires hospital administration approval
*Very serious decision given consequences to community
*Above ALS diversion triggers AND  
*Above ALS diversion triggers AND  
* Number of ambulance triage and #ESI 2’s in waiting room = 5-8
*'''3 patients in ambulance triage waiting >60 min''' AND one of the following:
*WR #s = 50-60
**At least 2 #ESI 2’s in waiting room  
*WR LOS = >12hrs
**WR #s = 50-60
*No trauma bays open
**WR LOS = >12hrs
*OCN to notify Clinical Nursing Director or designee + Attending to notify [[Harbor:DEM_Admin_on_Duty_(AOD)|DEM AOD]] --> Approval by CMO/CEO or designee
**No trauma bays open
*ED request for “BLS ED Sat” must come from the Clinical Nursing Director and ED AOD via the OCN and Attending. Hospital approval by CMO/CEO or designee.
*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet
 




[[Category:Admin]]
[[Category:Admin]]

Latest revision as of 00:37, 28 December 2021

ALS Diversion

  • ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.
    • “ALS ED Sat” does NOT redirect BLS arrivals or specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal)..
  • ALS ED Sat” lasts for two hours but can be ended earlier. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to ALS.
  • If the nearest alternative ED is also noted as “ALS ED Sat”, ALS ambulances will be directed to the closest ED, regardless of “ED Sat” status on ReddiNet.
  • “ALS ED Sat” is not a command, but a suggestion. EMS can still bring the patient to the MAR if it is considered to be the safest decision (e.g. patients in extremis)
  • Goal of Diversion is to ensure safety of current ED patients and of patients being transported by EMS by::
    • Allowing staff time to move patients within or through the ED to free up space/staff resources.
    • Allowing the ED time to prepare for next round of sick patients.


Guidelines for ALS Diversion triggers:

  • Consider when not enough space to care for the next critical patient coming by ambulance
    • Not enough treatment spaces despite decompress patients to other beds/hallway
    • Not enough staff (RN, RT, provider, etc.) or supplies (vents, blood, etc.)
  • Diversion decisions made by joint agreement of MICN, OCN, AED Charge, and Attending
  • OCN & Attending names are recorded in the ReddiNet as the Authorizing personnel


BLS Diversion

  • “BLS ED Sat” is added to ALS ED Sat and marks the ED in the countywide ReddiNet system as “closed” to all ALS and BLS arrivals.
  • “BLS ED Sat” does NOT redirect specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).
  • Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.
  • Requires hospital administration approval


Guidelines for BLS Diversion triggers: Requires hospital administration approval

  • Above ALS diversion triggers AND
  • 3 patients in ambulance triage waiting >60 min AND one of the following:
    • At least 2 #ESI 2’s in waiting room
    • WR #s = 50-60
    • WR LOS = >12hrs
    • No trauma bays open
  • ED request for “BLS ED Sat” must come from the Clinical Nursing Director and ED AOD via the OCN and Attending. Hospital approval by CMO/CEO or designee.
  • Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet
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