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Boarding of Admitted and Intensive Care Patients in the Emergency Department
Policy Statements
Recording Devices in the Emergency Department [Ann Emerg Med. 2011;58:110.] ACEP believes that the use of recording devices, including cell phone cameras, in the emergency department (ED) for the purpose of capturing photographic, video, or audio media poses significant risks to the privacy and confidentiality of patients and staff. ACEP encourages EDs to adopt policies regulating the use of such devices. Approved April 2011 Originally approved by the ACEP Board of Directors April 2011 doi:10.1016/j.annemergmed.2011.04.032
Physician Reporting of Potentially Impaired Drivers [Ann Emerg Med. 2011;58:110.] The American College of Emergency Physicians (ACEP) believes: ● reporting of potentially impaired drivers should be individualized to the patient’s clinical condition and the clear risk posed to the patient and public by continued driving; and ● physicians exercising good faith clinical judgments should have protection from liability for their reporting actions. ACEP opposes mandatory reporting of entire classes of patients or diagnoses (eg, epilepsy) unless compelling evidence exists for a public health benefit for such reporting. Approved by the ACEP Board of Directors April 2011 doi:10.1016/j.annemergmed.2011.04.024
Boarding of Admitted and Intensive Care Patients in the Emergency Department [Ann Emerg Med. 2011;58:110.] Optimal utilization of the emergency department (ED) includes the timely evaluation, management, and stabilization of all patients. Boarding of admitted patients in the ED contributes to lower quality of care, reduced timeliness of care, and reduced patient satisfaction. The ED should not be utilized as an extension of the ICU and other inpatient units for admitted patients because this practice adversely affects patient safety, quality, and access to care. ED leadership, hospital administrators, emergency medical services (EMS) directors, community leaders, state and federal officials, hospital regulators, and accrediting bodies should work together to resolve this problem. ED boarding is a hospital-wide problem, and the most effective care of admitted patients is provided in an inpatient unit. ED crowding is a direct result of diminished bed and resource capacity created by boarding. For the ED to continue to provide quality patient care and access to that care, 110 Annals of Emergency Medicine
the American College of Emergency Physicians (ACEP) believes that: ● Hospitals have the responsibility to provide quality patient care and optimize patient safety by ensuring the prompt transfer of patients admitted to inpatient units as soon as the treating emergency physician makes such a decision. If such a transfer cannot be promptly effected for whatever reason, the hospital must provide the supplemental nursing staff necessary to care for these inpatients boarded in the ED. ● In the event that the number of patients needing evaluation or treatment in an ED is equal to or exceeds the ED’s treatment space capacity, admitted patients should be promptly distributed to inpatient units regardless of inpatient bed availability. ● Hospitals should have staffing plans in place that can mobilize sufficient health care and support personnel to meet increased patient needs. ● Hospitals should develop appropriate mechanisms to facilitate availability of inpatient beds. ● Emergency physicians should work with their hospital administration and medical staff to monitor and improve the use of inpatient resources. ● Staffing patterns applicable to other specialized areas/units of the hospital should apply equally to the ED to ensure that patients receive a consistent standard of care, appropriate for the acuity of their condition, within the organization. ● Mutual aid agreements should be in place to assist any hospital that is unable to meet the emergency and intensive care needs of its community. ● Hospital diversion should be instituted only when internal resources have been exhausted and other community facilities have resources available to meet the needs of patients presenting to their facilities. EMS systems should develop mechanisms to address patient diversion by health care facilities, using the ACEP policy on ambulance diversion. ● Hospital regulatory and accrediting bodies should mandate standards for prompt transfer of admitted patients from the ED to inpatient units. When prompt transfer does not occur, established overcapacity contingency plans should be implemented. Revised and approved by the ACEP Board of Directors January 2007, April 2008, and April 2011 Originally approved by the ACEP Board of Directors October 2000 doi:10.1016/j.annemergmed.2011.04.027
Specialty Hospitals [Ann Emerg Med. 2011;58:110-111.] The American College of Emergency Physicians (ACEP) believes that quality patient care can be supported within the existing health care system only if access to timely specialty Volume , . : July
Recording Devices in the Emergency Department [Ann Emerg Med. 2011;58:110.] ACEP believes that the use of recording devices, including cell phone cameras, in the emergency department (ED) for the purpose of capturing photographic, video, or audio media poses significant risks to the privacy and confidentiality of patients and staff. ACEP encourages EDs to adopt policies regulating the use of such devices. Approved April 2011 Originally approved by the ACEP Board of Directors April 2011 doi:10.1016/j.annemergmed.2011.04.032
Physician Reporting of Potentially Impaired Drivers [Ann Emerg Med. 2011;58:110.] The American College of Emergency Physicians (ACEP) believes: ● reporting of potentially impaired drivers should be individualized to the patient’s clinical condition and the clear risk posed to the patient and public by continued driving; and ● physicians exercising good faith clinical judgments should have protection from liability for their reporting actions. ACEP opposes mandatory reporting of entire classes of patients or diagnoses (eg, epilepsy) unless compelling evidence exists for a public health benefit for such reporting. Approved by the ACEP Board of Directors April 2011 doi:10.1016/j.annemergmed.2011.04.024
Boarding of Admitted and Intensive Care Patients in the Emergency Department [Ann Emerg Med. 2011;58:110.] Optimal utilization of the emergency department (ED) includes the timely evaluation, management, and stabilization of all patients. Boarding of admitted patients in the ED contributes to lower quality of care, reduced timeliness of care, and reduced patient satisfaction. The ED should not be utilized as an extension of the ICU and other inpatient units for admitted patients because this practice adversely affects patient safety, quality, and access to care. ED leadership, hospital administrators, emergency medical services (EMS) directors, community leaders, state and federal officials, hospital regulators, and accrediting bodies should work together to resolve this problem. ED boarding is a hospital-wide problem, and the most effective care of admitted patients is provided in an inpatient unit. ED crowding is a direct result of diminished bed and resource capacity created by boarding. For the ED to continue to provide quality patient care and access to that care, 110 Annals of Emergency Medicine
the American College of Emergency Physicians (ACEP) believes that: ● Hospitals have the responsibility to provide quality patient care and optimize patient safety by ensuring the prompt transfer of patients admitted to inpatient units as soon as the treating emergency physician makes such a decision. If such a transfer cannot be promptly effected for whatever reason, the hospital must provide the supplemental nursing staff necessary to care for these inpatients boarded in the ED. ● In the event that the number of patients needing evaluation or treatment in an ED is equal to or exceeds the ED’s treatment space capacity, admitted patients should be promptly distributed to inpatient units regardless of inpatient bed availability. ● Hospitals should have staffing plans in place that can mobilize sufficient health care and support personnel to meet increased patient needs. ● Hospitals should develop appropriate mechanisms to facilitate availability of inpatient beds. ● Emergency physicians should work with their hospital administration and medical staff to monitor and improve the use of inpatient resources. ● Staffing patterns applicable to other specialized areas/units of the hospital should apply equally to the ED to ensure that patients receive a consistent standard of care, appropriate for the acuity of their condition, within the organization. ● Mutual aid agreements should be in place to assist any hospital that is unable to meet the emergency and intensive care needs of its community. ● Hospital diversion should be instituted only when internal resources have been exhausted and other community facilities have resources available to meet the needs of patients presenting to their facilities. EMS systems should develop mechanisms to address patient diversion by health care facilities, using the ACEP policy on ambulance diversion. ● Hospital regulatory and accrediting bodies should mandate standards for prompt transfer of admitted patients from the ED to inpatient units. When prompt transfer does not occur, established overcapacity contingency plans should be implemented. Revised and approved by the ACEP Board of Directors January 2007, April 2008, and April 2011 Originally approved by the ACEP Board of Directors October 2000 doi:10.1016/j.annemergmed.2011.04.027
Specialty Hospitals [Ann Emerg Med. 2011;58:110-111.] The American College of Emergency Physicians (ACEP) believes that quality patient care can be supported within the existing health care system only if access to timely specialty Volume , . : July