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Code Yellow ED Census Alert

It is the policy of Mahaska Health Partnership to provide care to Mahaska Health Partnership Emergency Department Patients when the numbers or needs of the patients exceed available resources by rapidly mobilizing hospital staff to provide needed care, resuscitation, and stabilization of the patients. 

I.  Definition and Criteria: Code Yellow Alert:   May be utilized when the numbers of critical Emergency Department patients exceed the number of Emergency Department beds (7).

During high census times, a combination of the following triggers will result in the overhead page of a Code Purple, as determined by the House Supervisor or Emergency Department Physician

1.Near full Emergency Department beds 

2.High acuity/High volume of Emergency Department patients (i.e. traumas, chest pain, sepsis) 

3.High volume of patients in the Emergency Department waiting room

4.Admissions or transfers being held in Emergency Department beds

5.Heavy surgery / procedure schedule requiring inpatient beds from the Emergency Department.

II.  Team Members:
Emergency Department /EMS staff
On call Physician for the ED
Emergency Physician on duty
Laboratory technician
Radiology technician
Nursing Supervisor
Nursing resources from Med./Surg./CCU as determined by ED senior RN staff and nursing supervisor
Emergency/Admitting Department secretary as assigned by the Nursing Supervisor.
Switchboard operator or additional Admitting secretary on the 11-7 shift 

III.  Procedure 
A.  Based on Emergency Department capacity as determined by the Emergency Department physician, the EMS Director, or senior RN in his absence, with input by the Nursing Supervisor on duty, activation of a Code Yellow Alert will be initiated.

B.  Code Yellow alert activation begins in the Emergency Department.  The ED will notify the hospital operator who will page Code Yellow Alert over the hospital intercom and paging system. All in-house team members should respond ASAP.

With the initial overhead page, the following actions will occur within 30 minutes:

NURSING UNITS The Inpatient Charge Nurse or designee will immediately Reassess bed status and update as needed with the Nursing Supervisor.

CARE COORDINATION Nursing and Paramedic staff will immediately assess patients to accelerate transfers/discharges.

ENVIRONMENTAL SERVICES Supervisory staff will immediately assess bed status for priority cleaning (list of rooms).

HOUSE SUPERVISOR (or designee) Determine need to notify Executive Staff

IV.  Duties of the Code Yellow  Alert Team Members:
ED/Family Physicians:
Performs/completes patient assessment, treatment, and stabilization, including completion of the transfer/admission/discharge Process.  

Interpretation of radiographic studies as requested by the physician.

ED Nurses:
Triage of patients, assessments of patients, assists with procedures, makes team assignments, accompanies patients on  intra hospital transfers, assures all necessary paper work is completed.  (nursing notes, transfer papers, admission/discharge orders.)

ER Medics: 
Triage of patients, assessments of patients, assist with procedures, prepares patients for out of hospital transfer, accompanies patients on intra hospital transfers, and assists in completion of necessary paperwork.  (Nursing notes, transfer papers, admission/discharge orders)

Floor Nurses:
(As assigned by Nursing Supervisor or ED Staff).  Completes assigned duties (IV's, NG's, Foley's), recording of data (nursing notes) assists with assessments as assigned by the ED nursing staff

Nursing Supervisor:
Assists ED Nurse with assessments as assigned, communicates with families, assists with phone calls, assist    with care of ED patients, and accompanies patients on intra-hospital transfers as needed.

ED/ Admitting Secretaries:
Patient registration, assisting with phone/radio calls, assisting with initiation of on Call List as deemed necessary by Nursing Supervisor.. Notification of key on call staff only as directed.

Radiology Technician:
Brings portable X-ray machine to the ED and performs X-rays as ordered.  Completes additional radiologic procedures/CT as ordered.  Unstable patients will be accompanied to the Radiology Department by a nurse.

Laboratory Technician:
Obtains Laboratory specimens on patients as ordered. Performs tests and gives results to the ED in a timely manner.

V. Code Yellow Review:
All alert charts will be reviewed by the ED Medical Director and the ED Nursing Director.. .PI findings will be reviewed at the Emergency Services/Disaster Committee meetings.  Physician problems are reviewed by and action taken by the ED medical director and the Emergency Department /Disaster Committee peer review members. System or nursing problems are reviewed by and action taken by the EMS Director, Ambulance Director, ER Medical Director and the Emergency Services Committee.