BILL ANALYSIS Ó
SB 336
Page 1
Date of Hearing: July 6, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 336 (Lieu) - As Amended: May 16, 2011
Policy Committee: HealthVote:17-1
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires, until January 1, 2016, general acute care
hospitals with emergency departments (ED) to adopt certain
practices and protocols related to overcrowding. Specifically,
this bill:
1)Requires hospitals to calculate and record a crowding score
and categorize the score on a scale of one through six, as
defined, every four to eight hours, as specified.
2)Requires hospitals to develop and implement full-capacity
protocols for each of the six categories of the crowding
scale, and to file these protocols with the Office of
Statewide Health Planning and Development (OSHPD).
FISCAL EFFECT
1)Minor fee-supported costs to the Department of Public Health,
in the range of $20,000 annually, to verify compliance with
this bill's provisions in the course of conducting regular
licensing surveys of the state's 344 hospitals with emergency
departments.
2)Minor, absorbable costs to OSHPD to receive and file
full-capacity protocols from hospitals.
3)One-time cost pressure to University of California medical
centers, estimated in the range of $300,000, to implement this
bill's provisions.
4)Indirect cost pressure to the state and other purchasers of
health care related to hospital costs to implement this bill's
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provisions, likely in the range of millions of dollars in
total one-time costs statewide.
COMMENTS
1)Rationale . According to the author, ED overcrowding is a
serious problem that compromises emergency care and places
patients in danger. This bill attempts to address overcrowding
by requiring hospital EDs to calculate overcrowding scores and
implementing protocols associated with different levels of
overcrowding. The author states that the components of this
bill represent a simple, proven process that has successfully
reduced wait times and patient boarding (the practice of
"boarding" patients in the emergency department before they
can be formally admitted to a hospital bed) at LA
County/University of Southern California (LAC/USC) Medical
Center.
2)Background . ED overcrowding is a complex and consequential
issue. Although quantitative evidence of the impact of
overcrowding is limited, a 2006 Institute of Medicine report
noted that ambulance diversion (the closure of EDs based on
crowded conditions) can lead to catastrophic delays in
treatment for seriously ill or injured patients, and that
patient boarding may enhance the potential for errors, delays
in treatment, and diminished quality of care. Various policy
strategies have been suggested to address overcrowding,
including those related to (a) patient demand for ED services
on the front end, (b) patient treatment experiences in the ED,
and (c) patient dispositions following ED treatment, including
discharge from the ED, hospital admission, and transfer to
another facility.
This bill attempts to address patient treatment in the ED and
dispositions following ED treatment. For example, in a
scenario where the ED became dangerously overcrowded, staff
throughout various hospital units might be put on alert to
free up additional beds that might otherwise be unavailable in
order to improve patient flow through the ED.
3)Related Legislation .
a) AB 2153 (Lieu) of 2010 provisions were substantially
similar to those contained in this bill. AB 2153 died on
the Senate Floor inactive file.
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b) AB 911 (Lieu) of 2009 also contained provisions
substantially similar to those contained in this bill. AB
911 was vetoed by Governor Schwarzenegger, who stated that
it failed to address the underlying causes of overcrowding.
He also encouraged hospitals to address overcrowding on a
voluntary and individual hospital basis.
c) AB 2207 (Lieu) of 2008 would have required hospitals to
assess the condition of an emergency room via the National
Emergency Department Overcrowding Scale Score (NEDOCS)
score, every three hours and would have authorized
hospitals to use hallways, conference rooms, and waiting
rooms as temporary patient areas pursuant to hospital
full-capacity protocols. It also required hospitals to
increase their number of staffed beds. AB 2207 was held in
this committee.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081