Practice Alert

Emergency Department Overcrowding/Preparedness

During late fall and winter months, many hospitals experience peak periods of occupancy and demand for emergency department services. This traditionally occurs at this time of year, and in particular during the influenza season -- which may be affected by a vaccine shortage. To assist hospitals in planning, a memorandum has been issued to hospital CEOs (October 26, 2004).

Nurses working in emergency services are likely to be most affected and should be alerted to the directive from the Department of Health (DOH) to follow guidelines pertaining to emergency room preparedness, overcrowding, and diversion; monitoring and tracking of ER visits; and infection control strategies and influenza vaccine recommendations (per the Centers for Disease Control [CDC]) during the next few months.

Hospitals are asked to implement the following recommendations for standard respiratory precautions (also referred to by the Centers for Disease Control and Preventions as “respiratory hygiene/cough etiquette”) within the emergency department:

• Post signs prior to entering the emergency department to direct patients with respiratory symptoms to a specific area for triage.
• Provide surgical masks to all patients with symptoms of respiratory illness. Provide instructions on the proper use and disposal of masks.
• For patients who cannot wear a surgical mask, provide tissues and instructions on when to use them (i.e., when coughing, sneezing, or controlling nasal secretions), how and where to dispose of them, and the importance of hand hygiene after handling this material.
• Provide hand hygiene materials in waiting room areas, and encourage patients with respiratory symptoms to perform hand hygiene.
• Designate an area in waiting rooms where patients with respiratory symptoms can be segregated (ideally by at least 3 feet) from other patients who do not have respiratory symptoms.
• Place patients with respiratory symptoms in a private room or cubicle as soon as possible for further evaluation.
  Implement use of surgical masks by healthcare personnel during the evaluation of patients with respiratory symptoms.
• Consider the installation of plexiglass barriers at the point of triage or registration to protect healthcare personnel from contact with respiratory droplets.
• If no barriers are present, instruct registration and triage staff to remain at least 3 feet from unmasked patients and to consider wearing surgical masks during respiratory infection season.
• Continue to use droplet precautions to manage patients with respiratory symptoms until it is determined that the cause of symptoms is not an infectious agent that requires precautions beyond standard precautions.

Posters regarding this subject are available for hospitals on the influenza site on the New York State Department of Health website at www.health.state.ny.us; NYSNA's Nursing Practice program offers a Guideline Document for Hospitals (.pdf format; Adobe Acrobat Reader required).

For questions related to this alert, contact Education, Practice and Research: 800.724.NYRN, ext. 282

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