Harbor:Diversion for ALS and BLS
- 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 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