BILL ANALYSIS Ó
SB 336
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SENATE THIRD READING
SB 336 (Lieu and De León)
As Amended May 16, 2011
Majority vote
SENATE VOTE :38-0
HEALTH 17-1 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Gordon, Hayashi, Roger | |Charles Calderon, Campos, |
| |Hernández, Bonnie | |Davis, Donnelly, Gatto, |
| |Lowenthal, Mitchell, | |Hall, Hill, Lara, |
| |Nestande, Pan, | |Mitchell, Nielsen, Norby, |
| |V. Manuel Pérez, Silva, | |Solorio, Wagner |
| |Smyth, Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Mansoor | | |
| | | | |
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SUMMARY : Requires, until January 1, 2016, every licensed
general acute care hospital to assess the condition of its
emergency department (ED), using a crowding score, every four or
eight hours, and to develop and implement capacity protocols for
overcrowding. Requires every licensed general acute care
hospital that operates an ED to develop and implement full
capacity protocols, and requires these protocols to be filed
with the Office of Statewide Health Planning and Development
(OSHPD). Specifically, this bill :
1)Defines "crowding score" as the score calculated to measure
EDs and hospital overcrowding, with an equation, as specified,
using the following variables:
a) Total number of patients within the ED;
b) Total number of staffed beds in the ED, not to exceed
the number of licensed beds;
c) Total number of admissions waiting in the ED, including
patients awaiting transfer;
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d) Total number of acute inpatient hospital beds routinely
in use by the hospital, excluding beds in the newborn
nursery, neonatal intensive care unit, and obstetrics;
e) Total number of patients in the ED admitted to the
intensive care-critical care unit;
f) The longest admit time, in hours, including transfers;
and,
g) The wait time for the last patient waiting the longest
in the waiting room, in hours.
2)Defines "crowding scale" as the range of crowding scores that
are divided into six categories of which level one represents
the lowest level of crowding and level six represents the
highest.
3)Requires every licensed general acute care hospital that
operates an ED to determine a range of crowding scores that
constitutes each category of the crowding scale for its ED.
4)Requires every licensed general acute care hospital that
operates an ED to assess the condition of its ED by
calculating and recording a crowding score a minimum of every
four hours or, if after calculating and recording a crowding
score less than level four for the previous 30 days,
calculating and recording a crowding score a minimum of every
eight hours.
5)Requires that every licensed general acute care hospital that
has an ED and a census of 14,000 visits annually to calculate
and record the crowding score daily between 4:00 p.m. and 8:00
p.m.
6)Requires, by January 1, 2013, every licensed general acute
care hospital that operates an ED, to develop and implement,
in consultation with its ED staff, a full-capacity protocol
for each of the categories of the crowding scale that
addresses all of the following factors:
a) Notification of hospital administrators, nursing staff,
medical staff, and ancillary services of category changes
on the scale;
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b) Hospital operations, including bed utilization,
transfers, elective admissions, discharges, supplies, and
additional staffing;
c) ED operations, including diversion, triage, and
alternative care sites; and,
d) Planned response, if the organized medical staff by the
hospital for rounds discharges, coordination with the ED
and emergency consults for ED patients.
7)Requires every licensed general acute care hospital that
operates an ED to file its full-capacity protocols with the
OSHPD, and annually report any revisions to its protocols.
8)Sunsets the provisions of this bill on January 1, 2016.
EXISTING LAW :
1)Provides for the licensing and regulation of health
facilities, including general acute care hospitals, acute
psychiatric hospitals, and special hospitals by the Department
of Public Health (DPH).
2)Defines a general acute care hospital as a health facility
having a duly constituted governing body with overall
administrative and professional responsibility and an
organized medical staff that provides 24-hour inpatient care,
including the following basic services: a) medical; b)
nursing; c) surgical; d) anesthesia; e) laboratory; f)
radiology; g) pharmacy; and, h) dietary services.
3)Permits hospitals to provide emergency medical services, under
specified circumstances.
4)Establishes OSHPD to analyze California's health care
infrastructure, provide information about health care
outcomes, assure the safety of buildings used in providing
health care, insure loans to encourage the development of
health care facilities, and facilitate development of
sustained capacity for communities to address local health
care issues.
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FISCAL EFFECT : According to the Assembly Appropriations
Committee this bill will result in the following costs:
1)Minor fee-supported costs to DPH, 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
provisions, likely in the range of millions of dollars in
total one-time costs statewide.
COMMENTS : According to the authors, overcrowding in
California's EDs is a serious problem and a threat to the health
and safety of patients in need of care. The authors maintain
that California is currently the last in the nation with regard
to the number of EDs available to its residents, providing only
7.1 EDs for every one million people, compared to an average of
19.9 among other states. The authors assert that many hospitals
across the nation, including Los Angeles County University of
Southern California Medical Center (LAC-USC), have developed a
full-capacity protocol which is intended to ease tension in EDs
and cut wait times for patients. This plan, according to the
authors, assesses the level of overcrowding in an ED and sets
guidelines for hospital operations at each level of
overcrowding. The authors argue that the full-capacity protocol
plan at LAC-USC, which this bill emulates, has been
overwhelmingly successful in achieving safe and reasonable
emergency procedures for both hospitals and EDs. According to
the authors, wait times have been significantly reduced as a
result of the implementation of the full- capacity protocol plan
at LAC-USC.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
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