BILL ANALYSIS
AB 2153
Page 1
ASSEMBLY THIRD READING
AB 2153 (Lieu)
As Introduced February 18, 2010
Majority vote
HEALTH 18-1 APPROPRIATIONS 17-0
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|Ayes:|Monning, Fletcher, |Ayes:|Fuentes, Conway, Ammiano, |
| |Ammiano, Carter, Conway, | |Bradford, Charles |
| |Brownley, De Leon, Adams, | |Calderon, Coto, Davis, |
| |Eng, Gaines, Hayashi, | |Nava, Hall, Harkey, |
| |Hernandez, Jones, Bonnie | |Miller, Nielsen, Norby, |
| |Lowenthal, Nava, V. | |Skinner, Solorio, |
| |Manuel Perez, Salas, | |Torlakson, Torrico |
| |Smyth | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Audra Strickland | | |
| | | | |
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SUMMARY : Requires every licensed general acute care hospital
with an emergency department (ED) to assess ED overcrowding
every four or eight hours, as well as develop and implement
full-capacity protocols that address staffing, procedures, and
operations when an ED is overcrowded. Specifically, this bill :
1)Defines "crowding score" as the score calculated to measure ED
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;
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;
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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)Provides 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 p.m. and
8 p.m.
6)Requires, by January 1, 2012, 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;
b) Hospital operations, including bed utilization,
transfers, elective admissions, discharges, supplies, and
additional staffing;
c) Emergency department operations, including diversion,
triage, and alternative care sites; and,
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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
Office of Statewide Health Planning and Development (OSHPD),
and annually report any revisions to its protocols.
8)Sunsets the provisions of this bill on January 1, 2015.
FISCAL EFFECT : According to the Assembly Appropriations
Committee this bill has unknown, likely minor costs to hospitals
to periodically calculate the overcrowding score and to
implement the full capacity protocol. This bill generally
describes current practice and policies for hospital emergency
services. Many busy EDs must assess capacity and patient flow
frequently to determine whether they should go on diversion, for
example, during which ambulances are redirected to other
hospitals.
COMMENTS : According to the American College of Emergency
Physicians State Chapter of California, Inc. (Cal/ACEP), the
sponsor of this bill, overcrowding in California's EDs is a real
and continued threat to the health and safety of patients in
need. Cal/ACEP asserts that the full-capacity protocol required
in this bill has been overwhelmingly successful in achieving
safe and reasonable emergency procedures for both hospitals and
EDs. According to Cal/ACEP, many hospitals across the Nation,
including the Los Angeles County University of Southern
California Medical Center (LAC+USC), with the largest ED in the
state, implemented this approach at no additional cost and
experienced a dramatic reduction in ED overcrowding. Cal/ACEP
maintains that this bill provides an opportunity for relief that
is simple and proven and allows for rapid response with
practical solutions based on the ever-changing conditions in the
ED.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0003968