An inside look at the Overlook process
One of the focal points of the demand management process at Overlook Hospital in Summit, NJ, is a color-coded series of tables laying out green, yellow, orange, and red "states" for each of a number of departments/services and criteria and interventions for each. These criteria and interventions are further divided into zone keys: C (Census), A (Acuity), S (Staffing), and O (Others). A closer look at the emergency department (ED) shows how the process unfolds from state to state under C:
In the green state are the following criteria:
- < 100% ED occupancy
- Admission cycle times < 2 hours
- Critical care beds available (> 2)
In the yellow state, the criteria are as follows:
- > 30 patients in the ED
- Average admission cycle time > 2 < 4 hours
- < 2 critical care beds available
- Critical care holds > 1 hour
In the orange state, the criteria are:
- > 40 patients in the ED
- Average admission cycle time > 4 < 8 hours
- One critical care bed available
- Critical care holds > 2 hours
Finally, the red criteria are:
- > 50 patients in the ED
- Average admission cycle time > 8 hours
- No critical care beds available
- Critical care holds > 4 hours
Interventions progress in a similar fashion. For example, the seven interventions in the yellow state include having dietary pass out and collect meal trays and the initiation of bed status team meetings. For orange, there are 12 additional interventions, including chief nursing officer opening additional beds and swing units if feasible, and additional volunteers assigned to ED. In red, there are nine "red only" initiatives, including having security round every hour and going to bypass/divert status.
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