Hospital Capability Restriction Advisory Service

1. Summary

This policy is intended to facilitate optimal care of the emergency patient, recognizing that at times both Emergency Department and EMS resources are limited. Cuyahoga County Hospitals shall make every effort to avoid patient diversion. EMS agencies may assist in avoiding patient diversion by making every attempt to evenly distribute patients among the Emergency Departments located within their jurisdiction.

This procedure provides a means for hospitals to notify the CECOMS Center of restrictions in their patient care capabilities, and for the CECOMS Center to advise EMS squads/ communication centers and R.E.D. Center of these restrictions. Diversion shall be limited to use by a participating facility in the event that the facility is experiencing an internal or mechanical issue (e.g., equipment failure; facility power outage). If a facility must divert due to such an event, and the facility anticipates the diversion to be of a prolonged period of time, the facility shall contact their local EMS providers to discuss the potential time frame. Additionally, a conference call between the local health system’s Chief Medical Officers may be beneficial to assess any unmet needs of the community and EMS. Diversion data will be tracked and evaluated periodically to monitor the effectiveness of this policy.

2. Restriction Categories

The following are five standard restriction categories which shall be used by the CECOMS Center / R.E.D. Center. These categories and their meanings are as follows:

a. CRITICAL RESTRICTION – TRAUMA
This status indicates that the hospital is unable to provide emergency surgical treatment to a patient. This restriction might be put into effect, for example, if the operating room was already full to capacity or if the surgical team was not readily available. In the event ambulance personnel have a patient that will require emergency surgery and the nearest hospital has imposed this restriction, the EMS personnel should divert to the next nearest appropriate facility.

b. CRITICAL RESTRICTION – MEDICAL
This status indicates that a facility does not have available beds in either the Intensive Care Unit (ICU) or Coronary Care Unit (CCU). This status should be imposed only when beds are unavailable in either unit. This restriction recognizes that patients requiring intensive medical care can be accommodated at least temporarily in either unit.

c. FULL RESTRICTION
This implies that the hospital is unable to receive any patients transported by ambulance. No patient should be transported to a hospital which has imposed this restriction unless the patient’s condition falls within the “Exceptions to Restrictions” category defined in Section 3. This would apply, for example during acute overload of the Emergency Department with critical patients, or a completely full in-house occupancy.

d. TREAT AND RELEASE ONLY
This implies that the hospital is able to receive patients who are not likely to be admitted but are regarded as “treat and release”. This restriction further implies that the hospital is unable to receive patients who are likely to require admittance in order to be properly treated. No patient other than those regarded as treat and release should be transported to a hospital which has imposed this restriction unless the patient’s condition falls within the “restriction exceptions” category.

e. FULL RESTRICTION EXCEPT FOR TRAUMA
This restriction is available for use by Trauma Centers to permit them to severely limit admissions to their hospital while continuing to maintain trauma hospital availability. The purpose of this policy is to provide assurance that major trauma patients will be received at a trauma facility even though the trauma facility is unable to receive any other patients unless the patient’s condition falls within the “Restriction Exceptions” in section three.

3. Restriction Exceptions

There are situations, such as those listed below, when EMS personnel may need to transport a patient to a hospital on restriction. However, if diversion is due to an internal utility or plant issue (e.g., power outage, flood, fire), no patients shall be transported to the restricted facility.

1. Patients in cardiopulmonary arrest.
2. Patients with unstable airways that cannot be adequately managed by EMS personnel.
3. Patients felt to be in extremis and any diversion to another facility would dangerously delay needed immediate intervention.
4. Patients who are receiving ALS care and any diversion to another facility would extend transport time greater than 15 minutes.
5. Patients who typically receive their care at the hospital on diversion, and any diversion from that hospital would potentially jeopardize the expedient care of their emergency condition.

4. Restricted Authorization

The CECOMS Center will only accept restrictions or the removal of a restriction(s) from an authorized administrative representative of a hospital. Every year, the CECOMS Center shall update its list of administrative representatives authorized to place and remove a restriction. Should the administrative representative of the hospital change, the hospital is to inform the CECOMS Center of the change in writing.

5. RESTRICTION PLACEMENT /REMOVAL

It is the responsibility of the hospitals to immediately notify the CECOMS Center when a restriction is placed, removed and /or modified. To place or remove a restriction, the authorized hospital representative shall contact the CECOMS Center at (216) 771-1363. The CECOMS Center personnel will document the information, place in the CECOMS website, and send an email notification of the restriction placement, removal, or modification to hospital executives via Ready Notify. The administrative representative of the hospital will be called back for confirmation. Once the restriction placement or removal is received, the CECOMS Center shall immediately notify the R.E.D. Center of the status. Should the R.E.D. Center receive the notification, the CECOMS Center shall be notified immediately by the R.E.D. Center.

6. NOTIFICATION TO MUNICIPAL EMS PROVIDERS AND HOSPITALS

CECOMS will provide current hospital status information to all EMS departments and hospitals at any time upon request. It is encouraged that EMS providers contact CECOMS while enroute to a call or prior to patient transport.

CECOMS can be contacted as follows:

1.) Telephone (216) 771-1363

2.) MARCS – XMTAC 1 (7x platform Hailing Channel)

7. EMS SQUAD ADVISORY

Whenever an EMS squad contacts the CECOMS Center or the R.E.D. Center regarding a transport to a hospital with one of the aforementioned capability restrictions, the CECOMS Center / R.E.D. Center will advise the EMS squad of the restriction. It is the EMS squad's decision on whether to divert to another hospital. If requested by the EMS squad to do, the CECOMS Center / R.E.D. Center will:

a. Advise the EMS squad as to the status of nearby hospitals,
b. Notify the restricted hospital of the incoming transport, or
c. Place the EMS squad in communication with the restricted hospital.