The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
Division of Health Care Quality
10 West Street, 5th Floor, Boston, MA 02111
(617) 753-8000

ARGEO PAUL CELLUCCI
GOVERNOR
J ANE SWIFT
LIEUTENANT GOVERNOR
WILLIAM D. O’LEARY
SECRETARY
HOWARD K. KOH,M.D.,MPH
COMMISSIONER	

Circular Letter:  DHCQ 01-01-409

TO:	 	Chief Executive Officers, Massachusetts Hospitals
FROM: 	Paul I. Dreyer, Ph.D., Director
SUBJECT:	Temporary Placement of Medical /Surgical Patients into TCU Beds/	
		Relicensure of Previously Licensed Space
DATE:             January 19, 2001
This letter provides guidance to hospitals on two issues:
1.	The Department's policy regarding the temporary placement of medical/surgical patients into Transitional Care Unit (TCU) beds; and
2.	The Department's policy on the relicensure of previously licensed -- but current unlicensed space.
The purpose of these polices is to facilitate hospitals' response to emergency department diversion. 
 1. Temporary Placement of Medical /Surgical Patients into TCU Beds.  The Department's policy allows hospitals with TCUs to place medical/surgical (m/s) patients temporarily into those beds during periods when hospital m/s beds are filled to capacity, and hospitals would otherwise divert ambulances from their emergency departments. 
The Department will conditionally approve such requests, for not more than three months, contingent on the following:
1.	The TCU must request to place beds out of service. If the number of beds is a portion of the nursing unit, the beds out of service must be contiguous.
 
2.	No TCU patient can be discharged to open the bed for m/s use. 

3.	A floor plan of the unit, which identifies the rooms/beds to be taken out of service, must be submitted with the facility’s request.
 
4.	The hospital must request approval to occupy temporarily the LTCF beds. The request must be accompanied by verification that all the hospital’s beds are full and the emergency department, for significant periods of time, has been on ambulance diversion status, or otherwise adversely affected by increased numbers of patients coming through the emergency department.

5.	The hospital must provide satisfactory evidence that sufficient nursing staff is available to care for these additional hospital patients. 

6.	The hospital must assure the department that it will not use the beds to care for patients suffering from communicable diseases.
 
The Department will issue a written approval once it has determined that all the conditions are met.  Questions about this process should be addressed to Ms. Gail Palmeri at (617) 753-8220.  Requests should be submitted to:

	Ms. Barbara Ross
	Division of Health Care Quality
	10 West Street
Boston, MA 02111

2.	The Department's policy on the relicensure of previously licensed -- but current licensed space.   Hospitals that have lost licensed m/s beds due to the automatic bed delicensure process mandated by Chapter 23, or that have otherwise delicensed m/s beds, may relicense those beds using an expedited process.  Hospitals wishing to relicense such beds should contact Ms. Jean Pontikas at (617) 753-8104.