HOSPITAL FULL ALERT CASCADE

Transcription

1 Introduction The purpose of this document is to provide information on the capacity status of (ACH) and to detail the expected actions when occupancy reaches levels that make efficient operation of the hospital difficult or impossible and a clinical risk arises within admitting departments such as Adult Emergency and the Admission and Planning Unit. It provides a tool to manage acute and elective admissions, and to minimize the risk of adverse outcomes to staff and patients due to overcrowding. Information description The following document outlines a three-stage cascade, defines the capacity for ACH via and pager alerts. which Criteria for activating the and pager systems and the necessary actions to be taken are outlined. Definitions For the purpose of this document Hospital Full refers to the ability of ACH to place patients in suitable beds. This may mean when all available regular bed spaces in the Emergency Department Admission and Planning unit are occupied or that the discharges in the General Wards do not allow for the expected admissions to be accommodated. If all regular spaces in Adult Emergency and the Admission and Planning Unit are filled then patients are next placed in the AED procedure, consulting and waiting rooms for assessment and treatment. Once these spaces are full the AED and APU are at Maximum Capacity. Hospital Full Alert Cascade Page 1 of 6

2 ALERT TRIGGER POINTS ACTION CHECKLIST & RESPONSIBILITIES YELLOW ALERT Two or more of the following triggers 20 patients waiting for bed after morning bed meeting ORANGE ALERT Two or more of the following triggers RED ALERT Any One of the following: General ward occupancy > 97% as per the Daily Status Report AED / APU > 70 patients > 8 patients on admission expect screen The Duty Manager may activate the alert at a lower tolerance if staffing and or acuity require it 25 waiting for beds after morning bed meeting General ward occupancy > 98% AED/APU > = 86 patients > 12 patients on admission expect The Duty Manager may activate the alert at a lower tolerance if staffing and or acuity require it ICUs/HDUs inability to place patients in home wards thus creating blocks to intensive care. General ward resourced beds 100% All alternative spaces are utilised in AED/APU Ambulances unable to unload new arrivals Note: All patients able to be transferred off Level 2 must have been moved prior to a Red Alert being issued. Bed / Duty Manager Raises an to Clinical Directors, Charge Nurses, Service Managers, detailing triggers that activated the Yellow Alert. Review elective list and identify patients who may be cancelled. Identify patients whose discharge is being delayed for non clinical reasons for possible action. Review the ability to flex up beds as required and as staffing allows. Charge Nurses/Medical staff Review patients for earlier discharge if possible. Maximise Transition Lounge usage (access Transition Lounge staff to assist if available). Actions as above for yellow alert plus: Bed / Duty Manager Raises an and pager alert to Clinical Directors, Charge Nurses, Service Managers, On Call Consultants and Registrars detailing triggers that activated the Orange Alert. Reschedule the elective admission of all non critical inpatients booked for operations and procedures. This is done in consultation with medical staff Make arrangements for patients whose discharge is delayed to be moved where possible. Flex up beds as required and staffing allows. Utilise senior nursing staff as required. Call back staff from study days. Completes a significant event form detailing triggers and actions. On Call Registrars/Consultants to round on own specialty patients in AED/APU for possible discharges. On Call Registrars/Consultants to triage Acute Referrals from GPs. Transit Services Manager / Duty Manager Arrange additional Transit Nurse resource to facilitate transfers to wards as required. Actions as above for yellow and orange alerts plus: Bed / Duty Manager Raises an and pager alert to Clinical Directors, Charge Nurses, Service Managers, On Call Consultants and Registrars detailing triggers that activated the Red Alert. Completes a Significant Event form Bed / Duty Manager / Nurse Leaders Patients to be placed in ward procedure rooms, day stay units or corridors if required to spread the clinical risk across the organisation Confirm with Duty / Bed Manager that all possible discharges of own specialty patients have been actioned, both in AED/APU and wards. Senior Medical Staff Senior medical staff at front of house triaging patients. Hospital Full Alert Cascade Page 2 of 6

3 THREE STAGE ADMISSION CASCADE PAGER ALERT The purpose of the pager alert is to inform designated staff that the hospital is reaching or is at full capacity. These staff will then take the following actions to prevent the hospital becoming gridlocked. The pager alert will be in two stages, ORANGE Alert Hospital Full and RED Alert Hospital Full The pagers will be activated through the Group Alert emergency call system. The decision to activate the pager alert will be made by the Duty Manager with the assistance of the Bed Manager during their working hours. Yellow Alert Personnel and expected actions Duty Manager / Bed Manager (during working hours) Raises an to Clinical Directors, Charge Nurses, Service Managers, detailing triggers that activated the Yellow Alert. Review elective list and identify patients who may be cancelled. Identify patients whose discharge is being delayed for non clinical reasons for possible action. Review the ability to flex up beds as required and as staffing allows. Charge Nurses (notified by ) Review patients for earlier discharge if possible. Maximise Transition Lounge usage (access Transition Lounge staff to assist if available). Orange Alert Pager Personnel and expected actions Duty Manager / Bed Manager (during working hours) Raises an and pager alert to Clinical Directors, Charge Nurses, Service Managers, On Call Consultants and Registrars detailing triggers that activated the Orange Alert. The pager alert is activated by calling through to the call centre on 777. Reschedule all non critical inpatient operations and procedures in consultation with medical staff. Make arrangements for patients whose discharge is delayed to be moved where possible. Flex up beds as required and as staffing allows. Utilise senior nursing staff as required. Call back staff from study days. Completes a significant event form detailing triggers and actions. Charge Nurses (notified by ) Review patients for earlier discharge if possible. Maximise Transition Lounge usage (access Transition Lounge staff to assist if available). On Call Registrars/Consultants to round on own specialty patients in AED/APU for possible discharge. Consider calling, back up Registrar to help admit patients Consider extra ward round to expedite discharges On Call Registrars/Consultants to triage Acute Referrals from GPs. Transit Services Manager / Duty Manager Arrange additional Transit Nurse resource to facilitate transfers to wards as required. ADHB Nursing/Midwifery Bureau Contact Duty Manager check staffing requirements Hospital Full Alert Cascade Page 3 of 6

4 Red Alert Pager Duty Manager / Bed Manager (during working hours) Raises an and pager alert to Clinical Directors, Charge Nurses, Service Managers, On Call Consultants and Registrars detailing triggers that activated the Red Alert. The pager alert is activated by calling through to the call centre on 777. Reschedule all non critical inpatient operations and procedures in consultation with medical staff. Make arrangements for patients whose discharge is delayed to be moved where possible. Flex up beds as required and as staffing allows. Utilise senior nursing staff as required. Call back staff from study days. Completes a significant event form detailing triggers and actions. Duty Manager / Bed Manager (during working hours) / Nurse Leaders Patients to be placed in ward procedure rooms, day stay units or corridors if required to spread the clinical risk across the organisation Charge Nurses (notified by ) Review patients for earlier discharge if possible. Maximise Transition Lounge usage (access Transition Lounge staff to assist if available). On Call Registrars/Consultants to round on own specialty patients in AED/APU for possible discharge. Confirm with Duty / Bed Manager that all possible discharges within their own specialty have been actioned, both in AED/APU and wards. Consider calling, back up Registrar to help admit patients On Call Registrars/Consultants to triage Acute Referrals from GPs. Senior Medical Staff Senior medical staff to be at front of house triaging patients Transit Services Manager / Duty Manager Arrange additional Transit Nurse resource to facilitate transfers to wards as required. ADHB Nursing/Midwifery Bureau Contact Duty Manager check staffing requirements Hospital Full Alert Cascade Page 4 of 6

5 Red Alerts Bed/Duty Manager Alert Decision Tree Hospital Full - Orange Alert Use the following Group Call: Orange Alert Pager No Group Alert Duty Manager ADHB Nursing Bureau Bed Managers Surgical Bed Managers Medical Medical Registrar Surgical Registrar Orthopaedic Registrar Respiratory Registrar To be added on Duty / Bed Manager discretion On Call Medical Consultant On Call Surgical Consultant On Call Orthopaedic Consultant On Call Respiratory Consultant Hospital Full Alert Cascade Page 5 of 6

6 Stage 3 Alert Use the following Group Call: Red Alert Pager No Group Call Duty Manager ADHB Nursing Bureau Bed Managers Surgical Bed Managers Medical Medical Registrar Surgical Registrar Orthopaedic Registrar Respiratory Registrar Neurology Registrar Neurosurgery Registrar Urology Registrar Haematology Registrar Oncology Registrar Cardiology Registrar ORL Registrar Renal Registrar To be added at the Duty / Bed Managers discretion. On Call Medical Consultant On Call Surgical Consultant On Call Orthopaedic Consultant On Call Respiratory Consultant On Call Neurology Consultant On Call Neurosurgery Consultant On Call Urology Consultant On Call Haematology Consultant On Call Cardiology Consultant On Call ORL Consultant On Call Renal Consultant On Call Oncology Consultant Hospital Full Alert Cascade Page 6 of 6