BILL ANALYSIS
AB 911
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Date of Hearing: May 6, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 911 (Lieu) - As Introduced: February 26, 2009
Policy Committee: Health Vote:11-3
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires hospitals to assess the condition of an
emergency department (ED) via the "National Emergency Department
Over Crowding Scale" score (NEDOCS) every three hours. NEDOCS
scaling includes a range of scores from "not busy" to
"dangerously overcrowded." In addition, this bill:
1)Requires hospitals to develop and implement a full capacity
protocol for each of the categories of overcrowding as
determined by the NEDOCS score.
2)Requires hospitals to file full capacity protocols with the
Office of Statewide Planning and Development (OSHPD).
FISCAL EFFECT
1)Annual GF costs and cost pressures of $1 million to the
University of California and county-operated medical centers
to comply with the NEDOCS reporting every three hours.
2)One-time fee-supported special fund costs of $170,000 to the
California Department of Public Health (DPH) to establish
regulations and maintain oversight of requirements of this
bill during licensure and certification processes.
3)Unknown costs to OSHPD to accept full capacity protocols. This
bill does not specify that OSHPD needs to do anything other
than receive the protocols.
4)Preliminary research indicates efforts to reduce ED
overcrowding may reduce costs and increase revenues. By having
patients, pending admission, waiting in the ED longer than
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necessary, EDs may be failing to best utilize treatment
capacity. According to the sponsors of this bill, studies
focused on ED length-of-stay, ambulance diversions, and
quality of ED are all impacted positively when ED overcrowding
is reduced.
COMMENTS
1)Rationale . This bill is sponsored by the American College of
Emergency Physicians, California Chapter (CalACEP) to address
overcrowding in California EDs. Hospitals agree that ED
overcrowding is a problem facing patients and hospitals.
Boarding, a particular problem, occurs when a physician has
decided to admit a patient, but hospital units are unable to
admit the patient due to delays in discharges, testing, or
other barriers to moving a patient to admission in a timely
way. The reasons for ED overcrowding are varied, including
health access problems of insured populations, lack of care
for other patients, the aging of the population, and frequent
ED users. This bill requires hospitals to measure ED volumes
and wait times, to focus on a scale that provides a
description of ED status to professionals throughout the
hospital, and requires EDs to plan accordingly with respect to
full capacity protocols.
2)NEDOCS is an online tool that relies on eight objective data
fields, such as number of ED beds, longest time a patient has
been waiting for admission to a hospital bed, and the longest
time a patient has been in the waiting room. Based on these
factors, NEDOCS provides a score that indicates how crowded
the ED is. According to the sponsor, the tool takes
approximately 10 minutes to complete, relying on data EDs
should have readily available and in the absence of this
bill's requirements.
3)Los Angeles County Experience . Los Angeles County
(LAC)/University of Southern California (USC) medical center
has been using NEDOCS for the past two years and has seen a
significant improvement in moving patients from the ED to beds
more quickly. Effort has been expended from all parts of the
medical center to see that the NEDOCS score does not reach the
"dangerously overcrowded" designation, which is similar to
what a hospital would experience during a disaster. By
providing staff hospital-wide with a single focal point with
respect to ED care, patient time until admission has been
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reduced and length of stay for several thousand patients has
been reduced. Such reductions have the potential to reduce
cost pressures on EDs as well as in-patient units.
4)Concerns . The California Hospital Association (CHA) is opposed
to this bill. CHA indicates NEDOCS is an unproven method to ED
assessment and that NEDOCS takes hospitals away from patient
care. Academic research on the reliability of NEDOCS in terms
of measuring how crowded an ED is seems generally positive.
Some research indicates the NEDOCS tool is most effective in
large, busy EDs.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081