UMC studies ways to stop emergency overcrowding

By Emily Richmond (contact)

Tuesday, Nov. 6, 2001 | 9:44 a.m.

University Medical Center officials are considering new policies to prevent overcrowding, which in the past has led to the closure of the public hospital's emergency room.

When a hospital can no longer accept emergency room patients -- whether because of lack of space or a shortage of staff -- administrators put the facility on divert, which means patients are rerouted to other hospitals. Critically ill patients are always taken to the nearest hospital, regardless of divert status.

The new UMC policy, nicknamed "Code Alpha," would include an internal alert, sent via staff pagers and the public address system. The heads of various departments, including the emergency room, would then meet, said Jackie Taylor, chief operating officer for UMC.

"We didn't really have a defined policy for responding to a potential divert situation," Taylor said. "Code Alpha will allow us to quickly notify key individuals and figure out how to best maximize our resources."

That could mean canceling elective surgeries, calling in extra staff or consolidating wards, Taylor said.

Taylor said Code Alpha was designed in response to a new policy approved in March by Clark County's medical advisory board. In an attempt to shorten response times for paramedics, the board divided the Las Vegas Valley's hospitals and ambulance teams into three geographic regions. Under the new system, no two hospitals in the same region may simultaneously go on divert status.

Since the new system was implemented, paramedics have spent less time driving around the Las Vegas Valley searching for an open emergency room, said Sandy Young, the city of Las Vegas emergency medical services quality improvement coordinator and a member of the county's advisory board.

Patients are taken to hospitals more quickly and are more likely to go to a hospital near their homes, Young said. When no emergency rooms are on divert, ambulance drivers are free to take patients to any hospital they request, Young said.

If a hospital is forced to close -- and if another hospital needs to close as well -- the first hospital will have one hour to reopen, Young said.

Before March, hospital administrators could declare "critical care divert," meaning patients requiring the most intensive, specialized care could be refused, while the emergency room continued to care for patients with less serious ailments. Administrators could also use "emergency room divert," where all patients were sent elsewhere.

The new policy eliminated the two levels of divert, and a hospital's emergency room is now considered either open or closed, Young said.

As the county's only public hospital, UMC cannot turn away patients, and its emergency room is already facing a heavier load than other facilities, Taylor said. Since March there have been at least two instances when UMC was on divert and was told to reopen sooner than the emergency room staff would have liked, Taylor said.

Desert Springs Hospital already has in place a system similar to the Code Alpha being considered by UMC. Since implementing its Divert Avoidance Response Team in August 2000, Desert Springs has seen a dramatic reduction in emergency room closure time, said Karla Perez, the hospital's chief executive officer.

Desert Springs' emergency room was closed 80 percent of the time in July 2000, and just 5 percent in July 2001, Perez said.

"It used to be that a hospital would go on divert and then try and figure out how to get off it," Perez said Monday. "We decided to figure out how to avoid divert in the first place."