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Chapter Strategies and Resources to Address the Crowding Problem Legislative Approaches New York: Bill Introduced to Limit Boarding Time and Diversion In 2004 and 2005, the New York chapter supported introduction of legislation that would limit boarding in the Emergency Department to four hours and limit diversion. This legislation can be found at: http://assembly.state.ny.us/leg/?bn=S04926&sh=t (Chapter memorandum in support of this legislation is available from the ACEP State Legislative Office.) Arizona: Bill Passed to Repeal Law Requiring that Ambulances Always Take Patients to the ED (The Arizona chapter is the only chapter that reported that the crowding problem has improved in recent years in the 2005 survey of chapters on the crowding issue. The chapter has been engaged in a number of legislative, regulatory and coalition efforts to address crowding as well as funding and access issues. Some of the crowding-related initiatives are included in this report. A more complete description of chapter activities addressing these issues is also available.) In 2001, the Arizona chapter supported an effort to eliminate requirements that ambulances take all patients to an emergency department, regardless of the patient complaint and irrespective of the patient request. The passage of SB1319 eliminated that requirement and authorized the ADHS Director to draft new regulations to allow for alternative destinations under appropriate circumstances. This legislation was a direct result of meetings held by stakeholders to find solutions to ED crowding. For more information on SB1319 go to: www.azleg.state.az.us/legtext/45leg/1r/laws/0157.htm . Bill Passed Eliminating Notary Requirement for Involuntary Commitment of Psychiatric Patients The Arizona chapter sought legislative relief to expedite the disposition of psychiatric patients. The psychiatric involuntary commitment process in Arizona required a doctor or nurse to sign a notarized commitment. Since most emergency departments did not have a notary, this requirement often necessitated that the emergency physician or nurse go off-site to the authorized agency. The delay in disposition for these patients was obviously problematic. The passage of SB1378 removed the notary requirement for licensed professionals and allowed a facsimile copy to stand as the original. For more information on SB1378, go to: www.azleg.state.az.us/legtext/43leg/1r/laws/0285.htm Bill Passed Raising Standards for Urgent Care Centers to Handle Emergency Cases In 1998, an effort was made to regulate urgent care centers after there were several documented incidents of patients with heart attacks, strokes, and respiratory failure presenting to urgent care centers ill-equipped to handle these true emergencies. The Arizona chapter was successful in forwarding legislation requiring the Department of Health Services to license urgent care centers and develop new regulations providing minimum standards for equipment, training, and staff to handle unanticipated emergency conditions. This legislation elevated the capacity of the entire community to better handle emergency care at alternative sites without placing patients at risk. For more information on SB1098: http://www.azleg.state.az.us/legtext/44leg/1r/laws/0333.htm Bill Passed to Fund Extended Hours for Community Health Care Centers Believing that at least some of the ED crowding was being caused by those with no other access to alternatives to emergency care, an Arizona senator sponsored a bill to allocate $500,000 to community healthcare centers in urban areas to allow for extended clinic hours. While the success of the program is difficult to quantify, the funding allowed for desperately needed additional community resources. This program also reflected a change in thinking for many legislators. In the past ED crowding was simply attributed to people inappropriately using the ED for primary care. This was an effort to providing funding for alternatives. For more info on HB2238 go to: www.azleg.state.az.us/legtext/45leg/1r/laws/0374.htm |