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Medicine Matters

Sharing successes, challenges and daily happenings in the Department of Medicine

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Hopkins Access Line Triage

We can be proud of the high demand for our inpatient beds in the Department of Medicine, but the demand creates challenges. Patients accepted from other institutions via the Hopkins Access Line (HAL) and patients in our ED are often vying for the same beds. We recently implemented a HAL triage protocol to create a more consistent and transparent approach to assigning beds and to balance our mission to provide tertiary care to patients at other institutions with the need to ensure beds for patients admitted through the ED. The algorithm below is a snapshot of this new protocol.

We are also working on a system for accepting providers to identify if a HAL patient is level 1-4. Until the system is available, if you wish to expedite transfer of a patient who is level 1, please notify the bed managers at x7-8299 or via PING (bed coordinators) (no call is needed for EMTALA patients who are easy for Hal and the bed managers to identify). Please feel free to email or page me with any questions or issues related to HAL -

HAL Triage Algorithm

Level 1-Hold when on red alert but supersede ED patients otherwise

Special/Vulnerable Populations, including (for example):

  • EMTALA patients per regulatory stipulations
  • Inpatients with urgent diagnostic and/or therapeutic needs that JHH is uniquely equipped to provide (e.g. need for urgent imaging, CVDL, STEMI for PCI, need for urgent transplant evaluation or h/o transplant at JHH, patients with an LVAD, patients on Flolan, etc.)

Level 2-Accept as beds allow (e.g. when fewer than 5 patients are awaiting medicine beds in the ED and not on yellow alert and occupancy is less than 90%)

  • Inpatients from hospitals within the health system (e.g. Sibley, Howard County, etc.) who do not meet criteria for Level 1
  • Inpatients who receive all/majority of their care at JHH who do not meet criteria for Level 1

Level 3-Accept as beds allow (e.g. not on yellow alert and occupancy less than 88%)

  • Inpatients for whom JHH offers services not available at their current facility but which are not required urgently
  • Inpatients seeking subspecialty consultation not available at their current facility

Level 4-Accept only as space allows (e.g. when occupancy is less than 84%)

  • Inpatients being transferred at their request (who are not followed by JHH)
  • Inpatients seeking second or third opinions

-Carrie Herzke, Associate Vice Chair for Inpatient Operations


Kelsey Bennett