Capacity Escalation Procedure - | Health



Canberra Hospital and Health ServicesOperational ProcedureCapacity Escalation ProcedureContents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc501540770 \h 1Purpose PAGEREF _Toc501540771 \h 2Scope PAGEREF _Toc501540772 \h 2Section 1 – Capacity Escalation - Business Hours (0800-1700hrs) PAGEREF _Toc501540773 \h 2Section 2 – Capacity Escalation - After Hours (1700-0800hrs), weekends and public holidays PAGEREF _Toc501540774 \h 2Section 3 – Surge Beds PAGEREF _Toc501540775 \h 3Section 4 – Department of Neonatology PAGEREF _Toc501540776 \h 3Implementation PAGEREF _Toc501540777 \h 3Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc501540778 \h 4References PAGEREF _Toc501540779 \h 4Search Terms PAGEREF _Toc501540780 \h 4Attachments PAGEREF _Toc501540781 \h 4Attachment 1 - Canberra Hospital Capacity Escalation Procedure During Business Hours (0800-1700hrs) PAGEREF _Toc501540782 \h 6Attachment 2 - Canberra Hospital Capacity Escalation Procedure between 1700-0800 hours weekdays, weekends and public holidays PAGEREF _Toc501540783 \h 11Attachment 3 - Canberra Hospital Capacity Escalation Procedure Neonatology PAGEREF _Toc501540784 \h 18PurposeCanberra Hospital and Health Services provides Tertiary level care and hospital services to Canberra and its surrounding region. To ensure that the most appropriate care is provided a whole of hospital approach is required to address times where capacity exceeds available access to service. This procedure sets out the Canberra Hospital and Health Services (CHHS) overarching approach to identifying and responding to Canberra Hospital capacity during high demand situations or where capacity exceeds available service access.The aim of this procedure is to ensure hospital capacity concerns will be managed effectively and efficiently. ScopeThis procedure applies to all inpatient areas of the Canberra Hospital campus excluding Birthing and the Birth Centre. It outlines the processes that staff are required to follow when the hospital is experiencing high demand or where capacity exceeds available access to services.Section 1 – Capacity Escalation - Business Hours (0800-1700hrs)This procedure is to be applied during business hours (0800-1700hrs, Monday to Friday, see Attachment 1) and requires mandatory compliance. This procedure outlines three Alert Levels:ALERT Level 1 – beds available for new admissions and patient flow being achievedALERT Level 2 – Limited availability of beds, patient flow is compromisedALERT Level 3 – bed availability critical despite use of surge beds, services disruptedBack to Table of ContentsSection 2 – Capacity Escalation - After Hours (1700-0800hrs), weekends and public holidaysThis procedure is to be applied between 1700-0800 hours weekdays, weekends and public holidays (see Attachment 2) and requires mandatory compliance. This procedure outlines three Alert Levels:ALERT Level 1 – beds available for new admissions and patient flow being achievedALERT Level 2 – Limited availability of beds, patient flow is compromisedALERT Level 3 – bed availability critical despite use of surge beds, services disruptedBack to Table of ContentsSection 3 – Surge Beds Surge Beds are additional hospital capacity beds that are not staffed or operational. Surge beds are a way of responding to peaks in demand and can be activated at short notice, with additional staff. The Chief of Clinical Operations, Executive On call or their delegates have authority to open these beds when required.Short term activation can occur when the hospital is at Capacity Alert Level 2 in the procedure. As soon as the hospital returns to accept capacity, the surge beds should be deactivated. Longer term activation can occur during periods of known or predicted increase in activity i.e. during winter.Opening of surge beds will be done in consultation with the ADON Patient Flow, Patient Flow Manager, Divisional ADON’s and After Hours Hospital Manager. Staffing for these beds will be through the After Hours Hospital Manager.Opening of surge beds will be discussed and monitored at Bed Management meetings.Back to Table of ContentsSection 4 – Department of NeonatologyWhere capacity exceeds available access to service in the Department of Neonatology please see Attachment 3. Back to Table of ContentsImplementation Implementation of this procedure will include:Chief of Clinical Operations present the procedure at Executive Directors meetingDirector of Medical Services discuss procedure at Clinical Directors meetingPresent procedure at senior nursing forumsPresent at Directors of Allied Health meetingIncorporate procedure as part of daily Bed Management meetingBack to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationProceduresInter-hospital Transfer: Non Critical PatientsAdmission Discharge – Adults, Pregnant Women and NeonatesEmergency Department Admission to WardDischarge Summary Completion SOPClinical Record Documentation SOPLegislationHealth Records (Privacy and Access) Act 1997Health Act 1993Human Rights Act 2004Mental Health Act 2015Back to Table of ContentsReferencesAuckland District Health Board (undated) Hospital Full – Alert Cascade, Manual Auckland City HospitalJohn Hunter complex: hospital bed Alert / escalation planBack to Table of ContentsSearch Terms Escalation, Capacity management, Demand management, Patient Flow, Bed availability, Access Block, Bed Block, Patient Flow Unit, Access Unit, Surge beds, NeonatologyBack to Table of ContentsAttachmentsAttachment 1 - Canberra Hospital Capacity Escalation Procedure In hoursAttachment 2 - Canberra Hospital Capacity Escalation Procedure After HoursAttachment 3 – Canberra Hospital Capacity Escalation Procedure NeonatologyDisclaimer: This document has been developed by ACT Health, Division of Medicine / Coronary Care Unit specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved By24 January 2018Neonatal Information AddedCHHS Policy Committee, ED Crit Care and ED WY&CAttachment 1 - Canberra Hospital Capacity Escalation Procedure During Business Hours (0800-1700hrs)Alert TriggerResponseCapacity Alert LEVEL 1Two or more of the following:Hospital 90-94% occupancy across all divisions5 or below bed booked patients in the EDICU at capacity (funded beds)Patient Flow Unit Chief of Clinical Operations(CoCO) sends text message to divisional EDs re capacity issues & number of discharges required as a priority across all divisionsPatient Flow Manager (PFM)Prioritises patient discharges with divisional ADONsExecutive DirectorsInform Clinical Directors of capacity issues Medical LeadersClinical Directors to notify specialty teams to conduct a round as soon as possible & review EDDs ICUICU ADON to contact Calvary Hospital ICU NUM to discuss capacity issues & patients appropriate for transferICU ADON to notify ADON PF & stand up meeting convened with ICU Director/Medical Leads/Surgical DONMental Health ServicesPatient Flow Coordinator contacts other service providers such as Hyson Green, 2N, Brian Hennessy and Older Persons Mental Health Unit to discuss patients appropriate for transferUtilise Discharge Lounge to facilitate timely dischargeWard areasDischarge 1 patient within 2 hoursUtilise Discharge Lounge to facilitate timely dischargesSupport servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Wardspersons supervisor notified via page of capacity issueRadiology notified of capacity issue & redistribute resources to meet hospital demand Capacity Alert LEVEL 2Two or more of the following:Hospital 95-99% occupancy across all divisionsBetween 6 or 10 bed booked patients in the EDED Resuscitation room fullICU over capacity (funded beds)Isolation beds unavailableAmbulance offloads in ED corridorPatient Flow Unit Chief of Clinical Operations sends text message to EDs, CDs, Directors of Allied Health (DAHs), Operational Director of Adult Acute Mental Health Services & DONs re capacity issues & number of discharges required as a priority from those divisions Prioritises patient discharges with divisional ADONsADON PF escalates patient transfers to outlying hospitals where transfer delays have occurredADON PF activates message to be sent via pager “Capacity Alert LEVEL 2” to all registrars & RMOs for immediate review of EDDs for next 24 hours & risk stratification for early dischargeADON PF activates message to be sent via pager “Capacity Alert LEVEL 2” to Allied Health – prioritise patients flagged for D/C, redistribute resources to meet demandD/C patients to other hospitals including private as appropriateCohort patients as appropriateSurge beds used as approved by Director of Operations or delegatePFM/ADON PF reassess situation hourly and communicate de-escalation or escalationDecision to review the continuation of surgeryMedical LeadersClinical Directors to notify specialty teams to review EDDs for further potential discharges and expedite discharges ICUICU ADON to contact Calvary Hospital ICU NUM to discuss capacity issues & patients appropriate for transferICU ADON to notify ADON PF & stand up meeting convened with ICU Director/Medical LeadsNotification to CRRS consultant to re-direct retrievals where clinically appropriateMental Health ServicesPatient Flow Coordinator contacts other service providers such as Hyson Green, 2N, Brian Hennessy and Older Persons Mental Health Unit to discuss patients appropriate for transferPatient Flow Coordinator informs Allied Health clinicians in Acute Mental Health Unit of Capacity Alert Level 2 & prioritise patients flagged for D/C, redistribute resources to meet demandUtilise Discharge Lounge to facilitate timely dischargeWard areasUtilise Discharge Lounge to facilitate timely dischargesDischarge 1 patient within 2 hours Ward CNCs contacted by their ADON advising of capacity issue & request that CNCs identify further potential discharges. CNC to contact treating teams to inform them of patients potentially suitable for D/CIdentify patients appropriate for D/C to other hospitals (private and NSW)Support servicesAllied Health notified via page to prioritise patients flagged for D/C, redistribute resources to meet demandPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delayWardspersons supervisor notified via page of capacity issueRadiology notified of capacity issue & redistribute resources to meet hospital demandCleaners notified of capacity issue & to prioritise terminal cleans, redistribute resources to meet hospital demand Capacity Alert LEVEL 3Two or more of the following:Hospital ≥ 100% occupancyMore than 11 bed booked patients in EDAll surge beds openUnable to decant resuscitation roomUnable to admit patients from other hospitalsIsolation beds unavailable & cohorting unable to be implementedICU over capacity (funded beds)Considering cancellation of surgeryPatient Flow Unit Chief of Clinical Operations sends text message to divisional EDs, CDs, Directors of Allied Health (DAHs), Operational Director of Adult Acute Mental Health Services & DONs re capacity issues & number of discharges required as a priority across all divisions. Chief of Clinical Operations sends text message 2 hours later to targeted EDs, CDs and DONs re capacity issues & number of discharged requiredD/C patients to other hospitals including private as appropriateADON PF activates message sent via pager “Capacity Alert LEVEL 3” to all registrars & RMOs for immediate review of EDDs for next 24 hours & risk stratification for early dischargeADON PF activates message to be sent via pager “Capacity Alert LEVEL 3” to Allied Health – prioritise patients flagged for D/C, redistribute resources to meet demandExecutiveChief of Clinical Operations holds an Escalation Meeting with Executive staff (EDs, CDs, DAHs, Manager of Medical Imaging, Operational Director of Adult Acute Mental Health Services & DONs) to develop short term strategies to reach target of <95% capacity within 4 hoursDecision to review the continuation of surgeryCancel non-urgent meetings to enable executive teams to facilitate flow and hospital demand Medical LeadersClinical Directors to notify specialty teams to review EDDs for further potential discharges and expedite discharges Treating teams conduct ward rounds as a priority ICUICU ADON to contact Calvary Hospital ICU NUM to discuss capacity issues & patients appropriate for transferICU ADON to notify ADON PF& stand up meeting convened with ICU Director/Medical LeadsNotification to CRRS consultant to re-direct retrievals where clinically appropriateMental Health ServicesPatient Flow Coordinator contacts other service providers such as Hyson Green, 2N, Brian Hennessy and Older Persons Mental Health Unit to discuss patients appropriate for transferPatient Flow Coordinator informs Allied Health clinicians in Acute Mental Health Unit of Hospital Capacity Alert LEVEL 3 & prioritise patients flagged for D/C, redistribute resources to meet demandUtilise Discharge Lounge to facilitate timely dischargeWard areasDischarge 2 patients within 1.5 hoursWard CNCs contacted by their ADON advising of capacity issue & request that CNCs identify further potential discharges. CNC to contact treating teams to inform them of patients potentially suitable for D/CIdentify patients appropriate for D/C to other hospitals (private and NSW)Clinical staff in non-clinical roles redirected to assist with staffing surge beds Utilise Discharge Lounge to facilitate timely dischargesIncrease PTV availability to increase transfers out of hospital subject to availabilitySupport servicesAllied Health notified via page to prioritise patients flagged for D/C, redistribute resources to meet demandPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delayWardspersons supervisor notified via page of capacity issueRadiology notified of capacity issue & redistribute resources to meet hospital demand as a priorityCleaners notified of capacity issue & redistribute resources to meet hospital demand as a priorityDischarge Lounge operational hours extended to 7pm to facilitate more dischargesAttachment 2 - Canberra Hospital Capacity Escalation Procedure between 1700-0800 hours weekdays, weekends and public holidaysAlertTriggerResponse1700-0800Capacity Alert LEVEL 1Two or more of the following:Hospital 90-94% occupancy across all divisions5 or below bed booked patients in the EDICU at capacity (funded beds)EMU backing up – EMU full & 2 or more EMU bed booked patients awaiting admissionPatient Flow Manager/ After Hours CNC / After Hours Clinical Manager & After Hours Hospital Manager PFM & AH CNC/AHCM prioritise patient discharges with ward Team Leaders and After Hours Hospital ManagerAfter Hours Hospital Manager informs Surgical Registrar, Admitting Registrar for Medicine (ARM) & Paediatric Reg of capacity issuesAH CNC works with the ARM and Surgical Reg and AH CM works with the Paediatric Reg to assist patient flow. Medical LeadersARM, Surgical, Psych & Paediatric Reg’s in conjunction with JMO’s review EDDs for further potential discharges before 8pmCritical CareICU Consultant to contact Calvary Hospital ICU Consultant to discuss capacity issues & patients appropriate for transferWard areasWard Team Leaders review EDDs and prepare at least one patient with an EDD for the following day for discharge by 9amSupport servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Radiology notified of capacity issue & redistribute resources to meet hospital demandWardspersons supervisor notified via page of capacity issueWeekends & Public Holidays 0800-1700Patient Flow Manager/ After Hours Hospital ManagerPFM prioritises patient discharges with ward Team Leaders and After Hours Hospital ManagerAfter Hours Hospital Manager informs Surgical Registrar, ARM and Paediatric Reg of capacity issuesMedical LeadersMedical staff to conduct a round as soon as possible & review EDDs for further potential discharges and expedite dischargesCritical CareICU Consultant to contact Calvary Hospital ICU Consultant to discuss capacity issues & patients appropriate for transferWard areasDischarge 1 patient within 2 hoursSupport servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Radiology notified of capacity issue & redistribute resources to meet hospital demandAlertTrigger1700-0800Capacity Alert LEVEL 2Two or more of the following:Hospital 95-99% occupancy across all divisionsBetween 6 or 10 bed booked patients in the EDED Resuscitation room fullICU over capacity (funded beds)Isolation beds unavailableAmbulance offloads in ED corridorPatient Flow Manager/ After Hours CNC / After Hours Clinical Manager & After Hours Hospital Manager PFM & AHCNC/AHCM prioritise patient discharges with ward Team Leaders and After Hours Hospital ManagerAH CNC works with the ARM and Surgical Reg and AH CM works with the Paediatric Reg to assist patient flowAfter Hours Hospital Manager informs Surgical, ARM and Paediatric Reg’s of capacity issues & need to expedite dischargesAfter Hours Hospital Manager contacts Exec-Oncall +/- MH Exec On-Call to notify them of hospital status D/C patients to other hospitals including private as appropriateCohort patients as appropriateSurge beds used as approved by Exec On-call or delegateAH CNC/CMC reassess situation hourly and communicate de-escalation or escalation to After Hours Hospital ManagerMedical LeadersARM, Surgical, Psych and Paediatric Reg’s inform JMOs of capacity issues & request review of EDDs for further potential discharges before 8pmARM, Surgical, Psych and Paediatric Reg’s consider risk stratification for patients identified for early discharge (before EDD)Critical CareICU Consultant to contact Calvary Hospital ICU Consultant to discuss capacity issues & patients appropriate for transferWard areasWard Team Leaders review EDDs and prepare at least one patient with an EDD for the following day for discharge by 9amSupport servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Radiology notified of capacity issue & redistribute resources to meet hospital demandCleaners notified of capacity issue & to prioritise terminal cleans, redistribute resources to meet hospital demandWardspersons supervisor notified via page of capacity issueAlertTriggerWeekends & Public Holidays 0800-1700Patient Flow Manager/ After Hours CNC / After Hours Clinical Manager & After Hours Hospital Manager PFM prioritises patient discharges with ward Team Leaders and After Hours Hospital ManagerAfter Hours Hospital manager informs Surgical, ARM and Paediatric Reg’s of capacity issues & need to expedite dischargesAfter Hours Hospital Manager considers opening the Discharge Lounge to assist with patient flowPatient Flow Manager escalates patient transfers to outlying hospitals where transfer delays have occurredD/C patients to other hospitals including private as appropriateCohort patients as appropriateSurge beds used as approved by Exec On-call or delegateAH CNC/PFM reassess situation hourly and communicate de-escalation or escalation with ARM and Surgical RegistrarDecision to review the continuation of surgeryMedical LeadersARM, Surgical, Psych and Paediatric Reg’s inform JMOs of capacity issues & request review of EDDs for further potential discharges and expedite discharges ARM, Surgical, Psych and Paediatric Reg consider risk stratification for patients identified for early discharge (before EDD)Critical CareICU Consultant to contact Calvary Hospital ICU Consultant to discuss capacity issues & patients appropriate for transferWard areasDischarge 2 patients within 2 hours Ward Team Leaders contacted by Patient Flow Manager advising of capacity issue & request that they review patients and identify patients suitable for D/C, including to other hospitals if appropriate (private & NSW)Support servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Radiology notified of capacity issue & redistribute resources to meet hospital demandCleaners notified of capacity issue & to prioritise terminal cleans, redistribute resources to meet hospital demandWardspersons supervisor notified via page of capacity issueAlertTrigger1700-0800Two or more of the following:Hospital ≥ 100% occupancyMore than 10 bed booked patients in EDAll surge beds openUnable to decant resuscitation roomUnable to admit patients from other hospitalsIsolation beds unavailable & cohorting unable to be implementedPatient Flow Manager/ After Hours CNC / After Hours Clinical Manager & After Hours Hospital Manager PFM & AHCNC/AHCM prioritises patient discharges with ward Team Leaders and After Hours Hospital ManagerAfter Hours Hospital Manager informs Surgical Registrar, ARM and Paediatric Reg of capacity issues & need to expedite discharges D/C patients to other hospitals including private as appropriateAfter Hours Hospital Manager contacts Exec-Oncall+/- MH Exec On-Call & conducts teleconference including Patient Flow Manager/ AHCNC/AHCM to develop short term strategies to reach target of <95% capacity within 4 hoursExecutive On-callDecision whether to request beds at private hospitalsDecision to review the continuation of surgeryMedical LeadersARM, Surgical, Psych and Paediatric Reg’s in conjunction with JMOs review EDDs for further potential discharges before 8pmARM, Surgical, Psych and Paediatric Reg’s consider risk stratification for patients identified for early discharge (before EDD)Critical CareICU Consultant to contact Calvary Hospital ICU Consultant to discuss capacity issues & patients appropriate for transferWard areasWard Team Leaders review EDDs and prepare at least two patient with an EDD for the following day for discharge by 9amAH CNC/CMC notify ward Team Leaders of capacity issue & request that they review patients and identify patients suitable for D/C, including to other hospitals (private & NSW)Non-clinical staff redirected to assist with staffing surge bedsAlertTriggerWeekends & Public Holidays 0800-1700Support servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Radiology notified of capacity issue & redistribute resources to meet hospital demand as a priorityWardspersons supervisor notified via page of capacity issueCleaners notified of capacity issue & redistribute resources to meet hospital demand as a priorityDischarge Lounge operational hours extended to 7pm to facilitate more dischargesIncrease PTV availability to increase transfers out of hospital subject to availabilityPatient Flow Manager/ After Hours CNC / After Hours Clinical Manager & After Hours Hospital Manager PFM prioritises patient discharges with ward Team Leaders and After Hours Hospital ManagerAH Hospital Manager consider opening D/C Lounge to facilitate patient flowAfter Hours Hospital Manager informs Surgical Registrar and ARM of capacity issues & need to expedite dischargesAH Hospital Manager activates message sent via pager “Capacity Alert Level 3” to all registrars & RMOs for immediate review of EDDs for next 24 hours & risk stratification for early dischargeD/C patients to other hospitals including private as appropriateAfter Hours Hospital Manager contacts Exec-Oncall & conducts teleconference including PFM/ AHCNC/AHCMC to develop short term strategies to reach target of <95% capacity within 4 hoursAH CNC/CMC/PFM reassess situation hourly and communicate de-escalation or escalation with ARM, Surgical & Paediatric Reg’sExecutive On-callDecision whether to request beds at private hospitalsDecision to review the continuation of surgeryMedical LeadersARM, Surgical & Paediatric Reg’s review EDDs for further potential discharges and expedite discharges ARM and Surgical Reg consider risk stratification for patients identified for early discharge (before EDD)Conducts ward rounds as a priority AlertTriggerWeekends & Public Holidays 0800-1700Critical CareICU Consultant to contact Calvary Hospital ICU Consultant to discuss capacity issues & patients appropriate for transferWard areasDischarge 2 patients within 1.5 hoursPFM/AH CNC/CMC informs ward Team Leaders of capacity issue & request that they review patients and identify patients suitable for D/C, including to other hospitals (private & NSW)Non-clinical staff redirected to assist with staffing surge beds Support servicesPathology to process collections marked “Discharge Priority” without delayPharmacy to process discharge medications marked “Discharge Priority” without delay Radiology notified of capacity issue & redistribute resources to meet hospital demand as a priority Wardspersons supervisor notified via page of capacity issueCleaners notified of capacity issue & redistribute resources to meet hospital demand as a priorityDischarge Lounge operational hours extended to 7pm to facilitate more dischargesIncrease PTV availability to increase transfers out of hospital subject to availabilityAttachment 3 – Centenary Hospital for Women & Children Department of Neonatology [Neonatal Intensive care Unit (NICU) and Special Care Unit (SCN)] Capacity Escalation ProcedureLevelTriggersResponseResponsibilityNormal Activity/No Access BlockAbility to admit to NICU due to funded bed availability/full staffing/skill mixNo access block from NICU to SCNAbility to admit babies from within local NSW/ACT network area. (ACT: Calvary Bruce, Calvary John James, NSW: Queanbeyan, Batemans Bay, Bega, Bombala, Cooma, Cootamundra, Goulburn, Moruya, Pambula, Temora, Tumut, Wagga Wagga, Young, Yass) and other areasIf unit is over capacity ability to delay transfers when necessary. Transfers should continue to be planned according to usual flow pathways within business hours if beds S Bed state GREENAttendance at Flow Huddle 3x per day and multidisciplinary handover meeting daily by nursing and medical staff to identify all imminent or potential NICU admissions (from Birthing, Antenatal or external)Post Huddle ‘Huddle’ in NICU at 0830 with Consultant +/- Fellow, Assistant Director of Nursing (ADON), NICU and SCN Clinical Nurse Consultants (CNC), SCN Career Medical Officer/Fellow, Registrars.Ongoing discharge planning/preparation to facilitate timely discharge of chronic patients (by 10am where appropriate).Regular NICU CNC and Birthing Clinical Midwife Consultant (CMC) liaisonIdentify patients suitable for internal transfer (NICU, SCN, Postnatal ward (PNW), Paediatrics)Identification of patient health insurance status on daily list.Daily phone contact with Calvary Bruce SCN and Calvary John James SCN (when appropriate) and transfer of any local area patients when beds available. NICU and SCN CNC’s to update ADON re activity and admission requiring changes to staffing/skill mix.Fortnightly meetings with Paediatrics for planned patient transfers.After HoursPost Huddle ‘Huddle’ in NICU at 1600 hrs with Consultant +/- Fellow, ADON, NICU and SCN CNC’s. SCN CMO/Fellow, Registrars.Continue back-transfers to local area hospitals on weekends/public holidays, utilising rostered staff with Retrieval experienceAll staffLevel 1Increasing ActivityOne to two funded beds available in NICU/SCNAnd/or patient acuity high with staffing availability/skills for only 1 NICU admission within rostered allocationAbility to accept patients from local NSW/ACT network area; but limited capacity to accept outside the networkLimited ability to transfer patients to local SCN’s in next 24 hours due to their capacityNETS Bed state AMBERExtra Actions (within Hours)Identify and prioritise planned and potential early discharges/transfers at the 0830am Neonatal HuddleADON to facilitate transfers to PNW/antenatal ward (ANW)/Paediatrics if bed block.ADON to escalate to Calvary Bruce and Calvary John James Bed Management if receiving SCN unable to accept.All phone calls from external hospitals requesting transfer of a potential NICU admission to be discussed between Obstetric and Neonatal Consultant. Refer potential admissions (including from Calvary hospital or private obstetricians) to on-service obstetric consultant for prioritisation. Extra Actions (After Hours)Attend after hours Women Youth & Children (WY&C) Huddles to discuss potential transfers/ admissions within WY&C if bed block.All phone calls from external hospitals requesting transfer of a potential NICU admission to be discussed between Obstetric and Neonatal C - NICU, SCNConsultants on Service – Neonatology Fellow / RegistrarsADONAfter Hours include:Team LeadersAfter Hours Hospital Manager (CHHS)Level 2At CapacityNo funded beds available in NICU/SCNOr high patient acuity with no staffing availability/skillsIntensive Care / High Dependency funded beds occupied with no ability to transfer patients to SCN Minimal planned discharges within the next 24 hoursCalvary Bruce SCN (any patient) and Calvary John James SCN not accepting admissions in the next 24 hoursNo ability to transfer patients to regional Level 2 SCN using conventional transport in the next 24 hoursNETS Bed state REDExtra Actions (Within Hours)Alert on service obstetric team to identify patients at risk of delivery on ANW and Birthing for additional review and possible transfer out.When considered safe request obstetric patients requiring a NICU bed to be transferred to another facility.All phone calls requesting in-utero admission or transfer out to be discussed between Neonatal and Obstetric Consultants, with Perinatal Advice Line (PAL) involvement when necessary.In conjunction with CD and ADON consider back transfer of patients to regional Level 2 SCN’s utilising ACT NETS (if a backup team can be arranged).If a patient is identified for transfer to any level 2 and transfer refused by parents for social or financial reasons and can’t be resolved at a clinical level, to be escalated to ADON, Clinical Director.Extra Actions (After Hours)As aboveConsultants on Service – Neonatology and ObstetricsFellow / RegistrarsCNC - NICU, SCN, PaediatricsCMC - Birthing, PNW, ANWADON, ADON/MClinical DirectorAfter Hours include:Team LeadersAfter Hours Hospital Manager (CHHS)Level 3Over CapacityMaximum bed capacity 34Over funded beds in NICU/SCNIf lower patient acuity; > 3 over funded beds with limited/no ability for extra staff Or high patient acuity with limited/no extra staffing available/skills for current patients for > 8 hours or admissionsIntensive Care / High Dependency funded beds occupied with no ability to transfer patients to SCN No forecast discharges within the next 24 hoursNo ability to transfer patients to local or regional Level 2 SCN using conventional transport in the next 24 hoursNETS Bedstate REDExtra ActionsActively work to get back to Level 2 ASAPWritten /text notification of overcapacity status to WYC Executive Director, WYC Director of Nursing and Midwifery (DONM), Departmental Leads, and Access Unit by ADON Over capacity alert via wifi phonesDiscuss every patient for possible early discharges / transfers at Neonatal ‘Huddle’ including ADON and Consultant.Further Huddles 1200 and 1600hrs until de-escalationUtilise non-clinical neonatal staff to provide patient care where appropriate ADON and Clinical Director in conjunction with Executive Director will consider other options to facilitate transfers/discharges i.e purchasing beds for public patients to be transferred to Calvary John James Hospital.Notify Perinatal Services Network of no capacityExtra Actions (After Hours)Transfer patients to local and regional hosptials out of hours. (ADON required to approve if retrieval nurse called in)Consider ex-utero transfer of NICU patients Decison to review and cancel elective procedures and admissions Executive Director WYCClinical Directors – all DepartmentsConsultants on Service – Neonatology and ObstetricsWYC DONMADON, ADON/MCNC - NICU, SCN,PaediatricsCMC - Birthing, PNW, ANWAfter Hours include:Team LeadersAfter Hours Hospital Manager (CHHS)Access UnitExecuitve Director On call (after hours)AlertAs per NSW Critical Care Tertiary Referral Network (perinatal) advice and emergency treatment needs to be given by the referral hospital (Centenary Hospital for Women and Children) to all the local NSW/ACT network area irrespective of bed state. ................
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