Order-of-the-State-Public-Health-Officer-Hospital-Health-Care-System-Surge-FAQ Public Health Order Questions & Answers: Hospital & Health Care System Surge

​This Q&A is out of date and is for historical purposes only.

Public Health Order Questions & Answers: Hospital & Health Care System Surge

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​What does the Order do?

The Order supports California's health care delivery system by requiring hospitals statewide to accept transfer patients from facilities with limited ICU capacity when clinically appropriate.

Why are you implementing this Order now?

We know from previous surges in COVID-19 cases and hospitalizations that preparing early through statewide coordination is the best course of action. By acting now, we are ensuring all patients in California are receiving appropriate care and that no hospital, county or region will be overwhelmed by any potential increase in hospitalizations.

Who does the Order apply to?

The Order applies to all hospitals statewide.

When does the Order take effect?

The Order took effect on August 18, 2021.

How long will the Order remain in effect?

The State Public Health Officer will continue to monitor statewide data and will modify these terms as needed by the evolving public health conditions.

Are hospitals being encouraged to cancel preventative care?

No, the Order does not discourage or prohibit preventive care or elective or non-urgent surgeries.

Are hospitals already cancelling non-urgent surgeries?

Some hospitals are already decreasing or suspending non-essential surgeries or procedures to increase capacity to respond to an increase in hospitalizations.

Will this negatively impact patient care?

No, the Order will ensure all patients in California are receiving appropriate care and that no hospital, county or region is overwhelmed by any potential increase in hospitalizations.

What counties are in each CDPH Public Health Officer Region?

The 61 local health departments across the state are divided into 5 public health regions. For a list of counties within each region, see CDPH Regional ICU Capacity webpage, California Regions section.

 California Regions Map

Does the Order only allow ICU patients to be transferred?

No, hospitals meeting criteria may transfer any patient type that best helps alleviate their ICU burden, including non-COVID patients. Hospitals may only utilize the Order when they meet the criteria to decompress for a COVID surge.

If a hospital meeting criteria for the Order is sending a "medical surgical" patient, is the receiving hospital then determined by the number of "medical surgical" beds that it has?

No, hospitals being evaluated to receive patients are always determined by whether they have ICU capacity.

What if counties or hospital staff refuse to accept patients from neighboring counties?

Per the Public Health Order, hospitals are required to accept patient transfers when the criteria are met. These transfers will be directed by the Medical Health and Operational Area Coordinator (MHOAC) for local transfers, by the Regional Disaster Medical Health Specialist (RDMHS) for regional transfers and by the Director of the California Emergency Services Medical Authority (EMSA) or designee for statewide transfers.

What initiates a transfer? When can a region start transferring patients? When can a region stop accepting patients? What if a region that has been accepting patients from neighboring counties starts to see a surge?

Counties meeting criteria (under 10% ICU capacity for three days) for this Health Order may utilize the transfer out criteria when the MHOAC in that operational area determines the need at individual hospitals and initiates the process. CDPH should be notified immediately in writing. The Order can be renewed one or more times if an assessment on the seventh day shows that the county had under 10% ICU capacity for the prior three days. The Order provides for expansion to regional and statewide levels should it become necessary.

How will the Order be enforced? Under what authority will it be enforced?

The California Department of Public Health (CDPH) has licensing authority over hospitals. CDPH will use its full legal authority, including licensing authority, to enforce the Public Health Order. Enforcement can include issuance of a deficiency or could warrant a penalty or other actions where patient harm occurs.

Will a patient's insurance status or ability to pay be considered when transferring?

A patient's insurance status or ability to pay shall not be considered when making transfer decisions pursuant to this Public Health Order.

What is a MHOAC? RDMHS? EMSA?

Medical and Health Operational Area Coordinators (MHOAC) support the coordination of medical and health resources within an operational area (county) during an emergency or disaster.

Regional Disaster Medical Health Specialists (RDMHS) support the coordination of medical mutual aid within a region during an emergency or disaster.

The California Emergency Services Medical Authority (EMSA) coordinates California's medical mutual aid system during an emergency or disaster.

How are patient transfers usually coordinated within a county, region and statewide?

Patient transfers are usually coordinated directly between hospitals, and these types of transfers may continue. However, if hospital-to-hospital transfers are leaving the county, that information should be shared with the impacted MHOACs in both counties to maintain situational awareness, planning and coordination.

What is the role of the MHOAC, RDMHS and EMSA in transferring patients under the Order?

Patient transfers in counties that meet the criteria of this Order will be directed within a county by the Medical Health and Operational Area Coordinator (MHOAC), within a region by the Regional Disaster Medical Health Specialist (RDMHS), and across regions by the California Emergency Medical Services Authority. The MHOACs from the receiving counties will continue to provide bed availability and should determine the best hospital or hospitals to receive patients. When a receiving hospital is identified within the same county, the MHOAC will coordinate the transfer with the sending and receiving hospital.  When a receiving hospital is within the same region, the sending and receiving MHOACs, as well the RDMHS will coordinate the transfer with the sending and receiving hospitals.  When the transfer involves a receiving hospital outside of the sending hospital's region, EMSA will coordinate the transfer with the sending and receiving MHOACs as well as the California Emergency Command and Transfer Center to complete the required steps coordinating the actual transfer. Transfers occurring under this Order within the operational area or within a region may, but are not required to, utilize the California Emergency Command and Transfer Center.

How does this Order differ from the Hospital Surge Order issued in January 2021?

The January 2021 Order was issued during a time when the state was experiencing its largest surge of the pandemic and amid concerns that some hospitals would need to implement crisis care. That Order required hospitals to delay low- and intermediate-acuity surgical procedures. Neither of those measures is part of the current Order because the State is in a very different position. The widespread adoption of vaccines, the State's ongoing efforts to increase the rate of vaccination, and common-sense protections such as masking, when combined with the coordination and flexibility for hospitals provided by this Order and informed by prior experience in responding to surges, will ensure that all Californians continue to receive the care they need in our hospitals.

Will the state share information on which hospitals or regions meets the conditions of the Order? If not, why?

CDPH has shared regional data on the CDPH Regional ICU Capacity webpage. See Regional ICU Capacity data table.

Will the state share details on numbers of patients transferred and the details of the transfers? If not, why?

No, the department does not track this information nor are facilities required to report transfers between hospitals. Transfers may be appropriate and necessary for reasons not related to this Public Health Order.

What is a team nursing model and why is it significant?

The team nursing model brings together licensed nurses with different experiences and skills to care for a group of patients. This model supports the matching of nursing care tasks to the most appropriate nurse for a group of patients, rather than having one nurse perform all care tasks for a particular patient. For example, an ICU having 12 patients may assign those 12 patients to a nursing team consisting of ICU-experienced nurses as well as med/surg- or similarly-experienced- nurses. The ICU-experienced nurses will perform the tasks for which they are uniquely qualified for the group of patients, and the med/surg- or similarly-experienced-nurses will perform the nursing care tasks that they are qualified to provide for the group of patients.

What is a clinically appropriate transfer?

A clinically appropriate transfer would be based on the professional opinion of a licensed health care professional working within their scope of practice. This determination may include clinical facility leadership responsible for determining the capability of the hospital to provide care necessary to meet a patient's need.