EmailHospital Circular 4/1998
Date Issued:
14 April 1998
Publication:
4/1998
Contact:
Regional Office
Distribution:
Public Hospitals
Private
Hospitals
Ambulance
Services
Subject: Ambulance
Bypass of Public Hospital Emergency Departments, Ambulance Transport
to Private Hospital Emergency Departments and Non-Insured Patients presenting
to Private Hospital Emergency Departments
Purpose: To provide
ambulance services with clear direction for the transport of patients
when a public hospital emergency department is on ambulance bypass and
clarify hospitals’ responsibilities for the provision of emergency services
Background
Current Department of Human Services (DHS) policy on ambulance bypass of public hospital emergency departments and ambulance transport to private hospital emergency departments (13/96) was communicated to Agencies in 1996. The Consultative Council on Emergency and Critical Care Services has reviewed the current policy and recommended it be updated to include instructions on the delivery of patients directly to critical care units. These instructions are included in paragraph 18 of this circular.
Instructions on the arrangements for the payment of treatment received by non-insured seriously ill patients who self present to the listed private hospitals are also covered in paragraph 20 of this circular.
This policy is effective from 14 April 1998 and replaces the previous policy {Hospital Circular (13/96)} on this matter.
Ambulance Bypass
The basis for public hospital operations is that ambulance bypass of public hospital emergency departments should be minimised. Hospitals should manage their emergency departments to maximise their capacity to care for emergency patients. This requirement includes an appropriate admission policy and the integration of the functions of the emergency department with those of the rest of the hospital, to ensure smooth transfer of patients from the emergency department to inpatient facilities as required.
It is recognised, however, that there will be occasions when a hospital has no alternative but to request to be bypassed by the ambulance service for a defined period. In these circumstances, the following arrangements should apply:
All emergency department requests for ambulance bypass must be sought only by an authorised senior medical officer of the hospital, for example, the Medical Director, or Director, Emergency Services.
Hospitals should advise the ambulance service of the name/s of the senior medical officer/s who are authorised to seek ambulance bypass.
Before seeking ambulance bypass, the authorised officer should be satisfied that:
the emergency department has reached its maximum physical capacity and
the treatment of patients already in the emergency department could be significantly compromised by the delivery of additional patients requiring emergency treatment and
steps are already in place to correct/overcome the situation.
Requests to the Metropolitan Ambulance Service for ambulance bypass should be made direct to the Clinician at the MAS Communication Centre by phoning (03) 9298 1369.
Any decision
to seek a temporary exemption from the usual obligation of a public hospital
emergency department to receive emergency patients must be based on the
capacity of the emergency department to manage these patients appropriately.
A period
of ambulance bypass will be for an initial period of two hours or less.
If the situation has not changed within this initial period, the authorised
officer, after review, may request an extension of ambulance bypass for
a further period not exceeding two hours.
Where two
or more hospitals in the same area/zone are simultaneously on bypass,
the ambulance service is to notify those hospitals accordingly and inform
them that in these circumstances it may not be possible to honour the
bypass request.
Whenever
there is a planned restriction of emergency department capacity, for example,
for capital works purposes, the hospital should give the ambulance service,
DHS and other hospitals likely to be affected as much advance notice as
possible and provide details of the restrictions expected.
During a
bypass period, the ambulance service will make every reasonable effort
to convey patients to an alternative emergency department.
The ambulance
service will continue to monitor and report the incidence of ambulance
bypass requests to DHS.
The Consultative Council on Emergency and Critical Care Services strongly
encourages Hospital Chief Executive Officers to develop policies and procedures
to better manage the frequency with which their hospital's emergency department
is authorised to seek ambulance bypass and to report this frequency to
appropriate hospital committees and Health Care Network Boards.
Ambulance Transport to Private Hospital Emergency Departments
The ambulance services will convey patients, with the exception of people with time-critical trauma and children, to the Emergency Department of Epworth Hospital if:
a medical practitioner requests it; or
-
a patient requests it; or,
if the patient is not clear-headed, a person acting on the patient’s behalf requests it.
The ambulance services will convey patients, with the exception of people with time-critical medical conditions (both trauma and non-trauma) and children to the Emergency Department of the Dandenong Valley Private Hospital, John Fawkner Hospital, Knox Private Hospital, South Eastern Private Hospital, St John Of God Hospital (Ballarat) Or Warburton Hospital, if:
a medical practitioner requests it; or
-
a patient requests it; or,
if the patient is not clear-headed, a person acting on the patient’s behalf requests it.
In the event
of an immediate life-threatening medical emergency arising unexpectedly
during the transport of a patient (or, on the basis of the patient’s clinical
condition, at the discretion of the ambulance officers involved), ambulance
officers may choose to transport any patient to the nearest private or
public hospital emergency department.
The ambulance
service shall not convey acute undifferentiated patients (that is, those
patients who, prior to transport, have not been adequately assessed by
a medical practitioner) directly to a critical care unit. These patients
should be taken to an appropriate, properly equipped and staffed emergency
department (supported by the necessary clinical and investigative support
services) in a public hospital or to an emergency department in one of
the private hospitals listed in this circular.
Procedural factors which will need to be taken into account in the implementation
of this policy include:
recognition that the concepts of ‘time critical medical conditions’ (both trauma and non trauma) be as already defined by ambulance services;
recognition that for the purposes of the policy a child is a person younger than 16 years of age;
in a situation where no medical practitioner is present, ambulance officers will need to be confident that the patient (or, if the patient is not clear-headed, the person acting on the patient’s behalf) making the request for transport to the emergency department of one of the nominated private hospitals is clear-headed and that the request is therefore appropriate;
ambulance officers will be required to annotate the request for ambulance transportation to a private hospital emergency department on the Patient Care Record and, if practical, have such annotation signed by the patient or someone acting on the patient’s behalf;
a private hospital emergency department to which transport is requested should be within reasonable proximity to the point at which the patient’s journey begins. DHS does not recognise as appropriate ambulances transporting patients long distances to meet requests for admission to the emergency department of one of the nominated private hospitals especially as this has the potential to compromise patient care;
in the event of an immediate life-threatening medical emergency arising unexpectedly during the transport of a patient, ambulance officers may elect to transport any patient to the emergency department of one of the listed private hospitals;
there may also be instances where seriously ill patients self present to the emergency department of the listed private hospitals;
the significance of the particular type and level of private insurance held by patients remains a matter for discussion between individual patients (or their families) and the private hospital concerned; and
in no circumstances will ambulance services or individual ambulance officers be liable for the payment of hospital charges.
Arrangements for Non-Insured Patients Presenting to one of the Private Hospital Emergency Departments listed in this circular
In the case of 19 (f) and 19 (g) above, unless the patient elects to be treated as a private patient, the private hospitals will bear the cost of any treatment received in the first 24 hours. The Office of the Co-ordinator of Emergency and Critical Care Services will be available to assist in organising the transfer of public patients to a public hospital. If no suitable public bed is available the private hospital would be eligible for reimbursement of costs in a manner consistent with the policy already in place;
Monitoring and Review
The Department will continue to monitor the incidence of ambulance bypass as reported to it by ambulance services.
The Department will continue to monitor the utilisation of private hospitals by public patients, as reported to it by the Office of the Coordinator of Emergency and Critical Care Services.
DR C.
W. BROOK
Director
Acute Health
