IHA District E

Des Moines Hospitals Emergency Department
Bypass Protocol
January 2018

Des Moines hospitals will determine, using their own internal protocols, when their hospital needs to be bypassed for either trauma patients, or adult and/or pediatric patients arriving by ambulance. The terms for the four bypass situations will be “trauma bypass,” “adult emergency department bypass,” “pediatric emergency department bypass” and adult and pediatric emergency department bypass. Bypass protocols do not apply to laboring patients. For laboring patients EMS will need to call the hospital to determine if the hospital can accept the patient.

When a hospital has determined they need to go on bypass using the National Emergency Department Overcrowding Score (NEDOCS) along with other factors as a guide and based on initial discussions with the house supervisors and if not resolved with the charge nurses and if not resolved with the administrators on duty, the hospital will update EMResource (a web based emergency department status product of EMSystems) to initiate the process. Bypass situations are limited to 60 minutes and the hospital must reevaluate the bypass status every 30 minutes. The hospital must update EMResource when the hospital goes off trauma or adult and/or pediatric bypass. The resource and regional trauma facilities must communicate with each other to coordinate the bypass prior to going on bypass. Only one resource or regional trauma facility can go on the same bypass status simultaneously.

•	Trauma Bypass includes patients that meet the Iowa Trauma System definition of trauma, excluding patients who have been previously accepted by the hospital and physician.
•	Adult Emergency Department Bypass includes adult patients inbound by ambulance, excluding patients who have been previously accepted by the hospital and physician. Adult Emergency Department bypass indicates the hospital is at or has exceeded its capacity to care for adult patients.
•	Pediatric Emergency Department Bypass includes pediatric patients (17 years or under) inbound by ambulance, excluding patients who have been previously accepted by the hospital and physician. Pediatric Emergency Department bypass indicates the hospital is at or has exceeded its capacity to care for pediatric patients.
•	Adult and Pediatric Emergency Department Bypass includes both adult and pediatric patients inbound by ambulance, excluding patients who have been previously accepted by the hospital and physician. Adult and pediatric Emergency Department bypass indicates the hospital is at or has exceeded its capacity to care for adult and pediatric patients.

Current Emergency Department bypass status information should be communicated to the responding unit when dispatched. Each communication center is responsible for notifying the ambulances for which they dispatch. Ambulance services are encouraged to contact the hospital before the ambulance leaves the scene.
NEDOCS

(National Emergency Department Overcrowding Score)

Total Patients in ED- The number of total patients in the ED and confirmed transports / transfers at the time the score is calculated. This includes all patients in all areas including waiting patients, Fast Track patients, etc.

ED Beds - The total number of ED beds including hallways, chairs, fast track and other beds that can be used to serve patients at the time the score is calculated.

# Admits - The number of holdovers/admits, in the ED, at the time the score is calculated.

Total Hospital Beds - The total number of hospital beds. Most implementations use the number of licensed beds that can be used in case of a disaster.

# Vent patients in ED - The number of patients on ventilators/respirators (including BiPAP) in the ED at the time the score is calculated.

Longest Admit boarding time (in ED)- The longest admit holdover/boarding (in hours) at the time the score was calculated (Example: 3.5 = 3 hours 30 minutes).

Hrs longest wait in WR (Last Bed Time) - The wait time (in hours) from arrival to bed for the last patient called for a bed (Example: 1.33 = 1 hour and 20 minutes).
NEDOCS Score – Calculated numeric score (5 Level)

NEDOCS Level – N/B/O/S/D (see below)

0 - 50
Normal	
51 - 100
Busy	
101 - 140
Overcrowded	
141 - 180
Severe	
Above 180 Disaster	

Hour estimates

10 minutes after the hour – 0.17	40 minutes after the hour – 0.67 20 minutes after the hour – 0.33	50 minutes after the hour – 0.83 30 minutes after the hour – 0.50

Many thanks to the Baylor Health Care System for this tool!  

										Revised January 2018