Hospital Divert Notification
Name of person reporting divert
*
Please enter a value.
Contact number
*
Please enter a value.
Designation
*
Doctor
Nursing Services Manager
Unit or Department Manager
Hospital Managerr
Night Nursing Manager
Administration Assistant
Please enter a value.
ER24 Contact Centre Agent Name & Surname
Only complete this part if this form was submitted directly from the ER24 Contact Centre.
Company / Institution
*
Mediclinic
Netcare
Government Hospital
NHN
Independent Institution
Please enter a value.
Nursing Unit on divert
*
Medical (physician based)
Orthopaedics
Surgical
Cardiac
Neuro-surgical
Vascular
Emergency or EC (exceptional cases only)
X-Rays (including scan/MRI
Paeduatrics incl Neonatal
All Patients
Trauma
Obstetrics
ICU (please specify which ICU patients)
Specify:
Please enter a value.
Date closed from
*
Enter a value.
Invalid Date
Time closed from
HH:MM
(24 hour format)
*
Enter a value.
Date open
*
Enter a value.
Invalid Date
Time open
The diversion may not be in place for more than 4 hours in the emergency unit For all other nursing units divert may not extend for longer than until the start of the next shift.
HH:MM
(24 hour format)
*
Enter a value.
Reason for closure
*
Infrastructure Problem
All beds occupied
Specialist availability
Staff Shortage
Other
Specify:
Please enter a value.
Closure for
*
Triage Red/Orange Patients
Triage Yellow Patients
Triage Green Patients
ICU Patients
All Patients
E-mail (Authorising person)
*
Please enter a value.
Invalid Email Address.
Name of person authorising divert
*
Please enter a value.
Further notes
Note that this notification will only alert ER24 Contact Centre staff and operational management regarding the hospital divert. Notifications to other services should be done via your department / unit's standard notification process.