Effective Date: 6/2014 Assigned Number:
Last Reviewed Date: 5/2014 Folder:
Last Revised Date: 5/2014 Manual-Section:
Page(s): 1of 8 Supersedes: Code Purple/High Patient Volume
Keywords: Code Purple, High Capacity, High Patient Volume
Refer to:
Purpose:
The Capacity Management policy describes the procedures to be followed at times of unusually high patient volume and/or acuity to continually provide safe and effective patient care.
Policy:
At times of unusually high patient volume and/or acuity, a “Capacity Management” plan will be initiated to mobilize additional resources to safely meet patients’ needs.
Scope:
Chester County Hospital Definitions:
Capacity Management Calculator (CMC) is a tool that assesses hospital capacity by calculating a score between 0 and 14. The CMC score comprises the assessment of the availability of:
a. Medical patient beds b. Surgical patient beds c. Monitored patient beds d. Critical care patient beds
e. Surgical patients that require a patient bed
f. Cardiac catheterization patients that require a patient bed g. Emergency patients awaiting a patient bed
Capacity Watch is when the capacity management calculation score is 3 – 7. Capacity Alert is when the capacity management calculation score is >7.
High Patient Volume (HPV) is when the modified NEDOCS reaches a score of >140.
Note: National Emergency Department Overcrowding Score (NEDOCS) is a scoring system that calculates a score from 0 to 180 or greater using the following criteria:
a. Total number of patients in the Emergency Department (ED) b. Total number of ED beds
c. Total numbers of admissions in the ED at the time of scoring d. Total number of staffed hospital beds
f. Longest admit time in the ED
g. Longest wait time in the ED waiting room Procedure:
Capacity Management is when an increased demand for beds exists; the Nursing Director of the Week/Nursing Supervisor will assess hospital capacity at a minimum of every four (4) hours using the CMC tool.
Capacity Watch- when “Capacity Watch” is determined, the following responses occur: a. Nursing Supervisor/Director of the Week or Designee:
• Notify the Administrator on Call (AOC).
• During off-shift and weekend hours, notify the Nursing Director of the Week. • Notify the Switchboard Operator.
• Notify the IT Help Desk to post “Capacity Watch” and the number of beds needed with the date of the posting message on Soarian logon screen.
• “Capacity Watch” will remain in effect for (4) hours and must be renewed by the Nursing Director of the Week/Nursing Supervisor and notify the Switchboard Operator.
• When “Capacity Watch” is resolved, the Nursing Director of the Week/Nursing Supervisor will: a) Direct the Switchboard Operator to Alpha page that “Capacity Watch” is “All Clear”.
b) Notify the IT Help Desk to remove the “Capacity Watch” message from Soarian logon screen. b. Cardiology
• Notify all Interventional Physicians of capacity management status.
• Evaluate the daily schedule for potential bed needs with the interventionalist.
• Review staffing schedule to determine if there is staff available from the Cath Lab, Echo Lab, or EKG who can help in the Emergency Department. These duties may include, but are not limited to, nursing, assessments, transport of patients, EKG’s, and completion of nursing admission database.
• The charge RN is to identify staff to cover the Holding area to provide care for patients awaiting transfer to inpatient areas.
• Non-Invasive Cardiology will engage the Non-Invasive Cardiologist to read EKG’s, Echo studies, and stress studies on inpatients and place preliminary results on patient charts as soon as possible.
c. Case Management
• Case Management (CM)/Social Work (SW) will meet with the Unit Charge RN/Clinical Manager to discuss potential discharges/barriers to patient discharges.
• Identify with Inpatient Triage Nurse (ITN) any unit that may need discharge priority. • Send out an Alpha page to MICA to expedite discharges and downgrades.
• CM Director and Team Leaders will touch base with CM/SW to evaluate discharges and problem solve. • Obtain earliest possible transport times for discharged patients.
• Evaluate and prioritize bed board for routine, next, and stat cleans. Call the ITN/Nursing Supervisor to clarify priorities.
• EVS leadership/supervisor will continually evaluate the volume of discharge cleans and will adjust staffing as needed.
e. Laboratory
• When there is a conflict of priorities, the phlebotomist or lab technician will serve patients with the most urgent clinical needs first and then provide care to the patients needing to be evaluated for movement or discharge.
• Lab will be notified of any need for expedited services/results by Nursing. f.Nursing Office
• Determine if additional resources are needed to assist ED. Nursing Supervisor expedites patient placement.
h. Radiology
•
When there is a conflict of priorities, the technologists will prioritize and expedite ordered
studies with the most urgent clinical needs first and then provide imaging to the patients needing
to be evaluated for discharge.
•
Radiology will be notified of any need for expedited services/results by Nursing /Case
Management.
•
Determine if additional staff is needed to assist with transport to specific modalities. (ex. MRI)
Capacity Alert- when “Capacity Alert” is determined, the following responses occur:a. Nursing Supervisor/Director of the Week or Designee:
• Notify the Administrator on Call (AOC).
• During off-shift and weekend hours, notify the Nursing Director of the Week. • Notify the Switchboard Operator.
• Notify the IT Help Desk to post “Capacity Alert” and the number of beds needed with the date of the posting message on Soarian logon screen.
• “Capacity Alert” will remain in effect for (4) hours and must be renewed by the Nursing Director of the Week/Nursing Supervisor and notify the Switchboard Operator.
• When “Capacity Alert” is resolved, the Nursing Director of the Week/Nursing Supervisor will: a) Direct the Switchboard Operator to Alpha page that “Capacity Alert” is “All Clear”.
b) Notify the IT Help Desk to remove the “Capacity Alert” message from Soarian logon screen. b. Cardiology
• Notify all Interventional Physicians that the hospital is on alert for capacity management status. • Evaluate the daily schedule for potential bed needs with the interventionalist.
• Review staffing schedule to determine if there is staff available from the Cath Lab, Echo Lab, or EKG who can help in the Emergency Department. These duties may include, but are not limited to, nursing, assessments, transport of patients, EKG’s, and completion of nursing admission database.
• Initiate “Capacity Management” staffing process in conjunction with the charge RN for the Interventional Holding area coverage.
• Initiate “Capacity Management” staffing process in conjunction with the Charge RN for the Interventional Holding Area coverage.
• The charge RN is to identify staff to cover the Holding area to provide care for patients awaiting transfer to inpatient areas.
• Non-Invasive Cardiology will engage the Non-Invasive Cardiologist to read EKG’s, Echo studies, and stress studies on inpatients and place preliminary results on patient charts as soon as possible.
c. Case Management
• Case Management (CM)/Social Work (SW) will meet with the Unit Charge RN/Clinical Manager to discuss potential discharges/barriers to patient discharges.
• Identify with Inpatient Triage Nurse (ITN) any unit that may need discharge priority. • Send out an Alpha page to MICA to expedite discharges and downgrades.
• CM Director and Team Leaders will touch base with CM/SW to evaluate discharges and problem solve. • Obtain earliest possible transport times for discharged patients.
d. Environmental Services (EVS):
• EVS personnel are notified via pager of Capacity Management status.
• Evaluate and prioritize bed board for routine, next, and stat cleans. Call the ITN/Nursing Supervisor to clarify priorities.
• EVS leadership/supervisor will continually evaluate the volume of discharge cleans and will adjust staffing as needed.
e. Laboratory
• When there is a conflict of priorities, the phlebotomist or lab technician will serve patients with the most urgent clinical needs first and then provide care to the patients needing to be evaluated for movement or discharge.
• Lab will be notified of any need for expedited services/results by Nursing. f. Nursing Office
• Determine if additional resources are needed to assist ED. Nursing Supervisor expedites patient placement.
g. Nursing Units
• Once the bed is clean and ready, sending unit will fax/call report, and sending units will call receiving unit to expedite patient transfer.
h. Radiology
•
When there is a conflict of priorities, the technologist will prioritize and expedite ordered studies
with the most urgent clinical needs first and then provide imaging to the patients needing to be
evaluated for discharge.
•
Radiology will be notified of any need for expedited services/results by Nursing /Case
Management.
•
Determine if additional staff is needed to assist with transport to specific modalities. (ex. MRI)
i. Transport Services• Nursing Supervisor/Nursing Office will notify Lead Transporter to prioritize services. High Patient Volume (HPV)- when “HPV” is determined, the following responses occur:
a. ED Charge RN/Leadership
• Notify the Nursing Supervisor/Clinical Nursing Director of the Week who will then notify the Administrator on Call during off-shift and weekend hours
• Once approval is given by the Administrator on Call : the ED Charge Nurse will notify the Chester County 911 Center
Note: When the ED Charge RN notifies the 9-1-1 Center the hospital is experiencing high patient volume, the 9-1-1 communicator will make a courtesy notification to all EMS services by a general radio message and by a hospital status message on their mobile data computer.
• Patients that are enroute to the facility at the time of the notification will proceed to their original designation.
• The patients will be made aware by the EMS providers their hospital of choice is experiencing HPV.
• The patient may choose to be transported to another facility or may choose to be transported to their original destination.
• If the patient’s second choice is also experiencing HPV, they will be advised of that as well and will be given the opportunity to express their preference.
• If the patient has no preference and are considered stable by the EMS provider, they may be transported to a hospital that is not experiencing high patient volume.
• The Director of the Week/ Nursing Supervisor will notify the Switchboard Operator that “HPV” has been initiated.
b. The Nursing Director of the Week/Nursing Supervisor- in collaboration with the ED Charge RN/ED Physician will:
• Re-evaluate “HPV” status every 4 hours using the NEDOCS toolNotify the Chester County 9-1-1 Center Supervisor of the termination of “HPV.”
• Notify the Switch board Operator that “HPV” has ended.
Supplemental Documentation/Forms/Actions:
Addendum A: CCH Capacity Management Calculator (CMC) Tool
Addendum B: CCH National Emergency Department Overcrowding Scoring (NEDOCS) Tool
Approval:
Signature: _____________________________________ Date: ____________________ Name: Michael Barber
Title: Chief Operating Officer
Committee Approval (if applicable):
Committee Name: Patient Flow Committee Date Reviewed & Approved: 04/01/14 Committee Name: Organizational Excellence Committee Date Reviewed & Approved: 05/13/14
Name (Typed) Department
Owner(s): Michael Barber Chief Operating Officer
Administration
Author(s): Julie Musantry MSN, RN, CEN Quality Manager
Capacity
Management
Calculator
Medical Inpatient Beds (WWG, WW1, WW2)
1 to 3 beds available = 1 point
0 beds available = 2 points
Surgical Inpatient Beds (3 Lasko, 4N)
1 to 3 beds available = 1 point
0 beds available = 2 points Monitored Beds (3N, 4T, PINU)
1 to 4 beds available = 1 point
0 beds available = 2 points Critical Care Beds (ICU, CVU)
1 to 4 beds available = 1 point
0 beds available = 2 points OR Patient Beds Needed
10 to 14 patients or 5 Joint patients= 1 point
greater than 15 patients or 7 Joint patients= 2 points Cath Lab Patient Beds Needed
3 to 4 patients= 1 point
greater than 5 patients= 2 points ED Patients
5‐10 patients in OVF/Potential status= 1 point
greater than 11 in OVF/Potential status= 2 points
Total
Date:
Time:
Calculator Name: Green: 0‐2 points
Capacity Management Watch: 3‐7 points
Capacity Management Alert: >7 points
NEDOCS CALCULATOR
INSTITUTIONALCONSTANTS
Number of ED Beds Number of Hospital Beds
COMMON ELEMENTS
Total Patients in the ED
Number of Respirators in the ED
Longest admit time (in hours)
MODEL SPECIFIC
Total Admits in the ED
Waiting room wait time for last patient called
(In hours) NEDOCS SCORE- Clear Fields 00 to 20 Not busy 21 to 60 Busy 61 to 100 Extremely busy, not overcrowded 101 to 140 Over-crowded 141 to 180 Severely over-crowded 181 to 200 Dangerously over-crowded • Total Patients in the ED- the number of total patients in the ED at the time the score is calculated.
Includes all areas including waiting room, and all locations in the ED. • ED Beds- Total number of beds including hallways - 27
• # Admits /Observation patients- number of patients admitted and remaining in the ED
• Total Hospital Beds: Hospital beds staffed/ licensed for patients. Excluding OB/ L& D/ NICU/ Nursery - 172
• # Vent patients- Critical Care patients in the ED
• Longest Admit/ Observation time – longest time patient is held in the ED waiting for an inpatient bed • Longest wait in the Waiting Room- waiting for a bed in the ED- 1
