Table 2 Full capacity protocol adaptation framework

Green

Things that can be changed:

•Name of the protocol (e.g., escalation policy)

•Time of morning safety huddle

•Incentives for participation

•Format and wording of the protocol

Yellow

Things that can be changed/modify with caution:

•Number of levels (generally 3 or 4 levels)

•Activation triggers for each level

•Actions in each level

•Order of actions in each level

•Add other ED crowding interventions (e.g., use of discharge lounges, surgical smoothing)

•Generally aim to place no more than 1 to 2 patients on any one-inpatient hallway. Hospitals cautiously can change this to whatever is needed, depending on crowding situation, the physical environment on each inpatient unit, and available staff and resources in inpatient units.

Red

Things that cannot be changed/ignored:

•Do not change the order of the levels (sequence)

•Do not delete an entire level of the protocol

•Place patients in areas with access to a bathroom

•Place patients in areas that least obstruct flow

•Do not transfer patients who are not eligible to transport to inpatient hallways including:

1. Patients need intensive care unit (ICU) or cardiac care unit (CCU) bed

2. Patients requiring negative pressure room

3. Patients requiring 4 L or greater of oxygen

4. Patients that require suctioning

5. Patients with unstable vital sings

6. Patients with Glasgow Coma Score < 15

7. Mechanically ventilated patients

8. Psychotic patients

9. Patients that have diarrhea or are incontinent of stool

10. Patients at immediate risk of seizures

11. Patients with open wounds

12. Patients at high risk of bleeding

13. Children and patients who are 75 years and older

14. Patients with recent high-risk coronary artery disease

15. Patients with history of heart failure, stroke

16. Patients with history of peripheral arterial disease

17. Patients with chronic obstructive pulmonary disease