Harbor:Diversion for ALS and BLS

Diversion decisions made by MICN, Overall Charge RN and Area Charge RNs, and Attending huddle q4 hours prn

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
• Number of ambulance triage and #ESI 2’s in waiting room = 5-8
• 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