Regulatory Approaches

Massachusetts Department of Public Health’s Best Practices

The Massachusetts chapter has been working with its Department of Public Health for several years, which has resulted in the development of a “best practices” document for ambulance diversion and numerous related recommendations including protocols regarding care of admitted patients awaiting bed placement. These resources are available on the department’s web site at http://www.mass.gov/dph/bhqm/ambdiv.htm. The chapter’s efforts also resulted in the commissioner of DPH sending a letter to all hospitals outlining boarding protocols.  (Letter is available from the ACEP State Legislative Office.)

New York Department of Health Guidance Document

The Commissioner of the New York State Department of Health has issued guidelines on boarding and diversion.  (Guidelines are available from the ACEP State Legislative Office.)

Connecticut Commissioner of Health Guidance Document

The Connecticut chapter helped develop a guidance document to assist the State Commissioner of Health in devising plans to address the crowding problems. The chapter is still awaiting action.

Representation on the Delaware EMS Oversight Council

The Delaware chapter has raised awareness on the need to address the crowding problem through its representation on the Delaware Emergency Medical Services Oversight Council.  The Council was created by the governor to examine policies and procedures and evaluate the effectiveness of the EMS system, and make recommendations to the governor, legislature and other agencies on improving system quality and efficiency.  Other Council members include representatives of EMS agencies, the Department of Health and the Department of Homeland Security.

Meeting with Maryland’s Secretary of Health & Mental Hygiene on Psych Bed Availability

The Maryland chapter met with the Secretary of the Department of Health and Mental Hygiene to discuss concerns about the lack of psychiatric beds.

Meeting with Michigan’s Department of Community Health on Boarding

The Michigan chapter met with the Department of Community Health to discuss the New York legislative proposal suggesting that patients should be boarded outside of the ED.

Meeting with New Jersey’s Health Department on Boarding

The New Jersey chapter met with the Health Department and received a promise to lift the restriction on placing boarded ED patients in inpatient hallways if the appropriate hospital policies were in place. (Letter from Department of Health to hospitals is available from the ACEP State Legislative Office.)