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Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events

Published online by Cambridge University Press:  08 April 2013

Gabor D. Kelen ,
Melissa L. McCarthy ,
Chadd K. Kraus ,
Ru Ding ,
Edbert B. Hsu ,
Guohua Li ,
Judy B. Shahan ,
James J. Scheulen  and
Gary B. Green
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Abstract

Objectives: US hospitals are expected to function without external aid for up to 96 hours during a disaster; however, concern exists that there is insufficient capacity in hospitals to absorb large numbers of acute casualties. The aim of the study was to determine the potential for creation of inpatient bed surge capacity from the early discharge (reverse triage) of hospital inpatients at low risk of untoward events for up to 96 hours.

Methods: In a health system with 3 capacity-constrained hospitals that are representative of US facilities (academic, teaching affiliate, community), a variety (N = 50) of inpatient units were prospectively canvassed in rotation using a blocked randomized design for 19 weeks ending in February 2006. Intensive care units (ICUs), nurseries, and pediatric units were excluded. Assuming a disaster occurred on the day of enrollment, patients who did not require any (previously defined) critical intervention for 4 days were deemed suitable for early discharge.

Results: Of 3491 patients, 44% did not require any critical intervention and were suitable for early discharge. Accounting for additional routine patient discharges, full use of staffed and unstaffed licensed beds, gross surge capacity was estimated at 77%, 95%, and 103% for the 3 hospitals. Factoring likely continuance of nonvictim emergency admissions, net surge capacity available for disaster victims was estimated at 66%, 71%, and 81%, respectively. Reverse triage made up the majority (50%, 55%, 59%) of surge beds. Most realized capacity was available within 24 to 48 hours.

Conclusions: Hospital surge capacity for standard inpatient beds may be greater than previously believed. Reverse triage, if appropriately harnessed, can be a major contributor to surge capacity. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S10–S16)

Type
Original Research and Critical Analysis
Information
Disaster Medicine and Public Health Preparedness , Volume 3 , Issue S1 , June 2009 , pp. S10 - S16
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2009

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References

REFERENCES

1.Committee on the Future of Emergency Care in the United States. Hospital Based Emergency Care at the Breaking Point. Future of Emergency Care Series. Washington, DC: National Academies Press; 2006.Google Scholar
2.Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems. Joint Commission on Accreditation of Healthcare Organizations Web site. 2003. http://www.jointcommission.org/PublicPolicy/Emergency_Preparedness.htm. Accessed September 16, 2008.Google Scholar
3.Homeland Security Presidential Directive/HSPD-21. Public Health and Medical Preparedness. October 2007. http://www.dhs.gov/xabout/laws/gc_1219263961449.shtm#1. Accessed September 16, 2008.Google Scholar
4.Kaji, A, Koenig, KL, Bey, T.Current hospital disaster preparedness. JAMA. 2007;298:2188–2190.CrossRefGoogle ScholarPubMed
5.Hick, JL, Hanfling, D, Burstein, JL, et alHealth care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44:253–261.Google Scholar
6.Revised Chapter. Emergency Management. Long Term Care Accreditation Program. February 13, 2009. http://www.jointcommission.org/NR/rdonlyres/8C1D9673-297B-4B90-97D1-299767404CC9/0/B_RevisedChapter_LTC_EM_20090213.pdf. Accessed March 26, 2009.Google Scholar
7.Kelen, GD, McCarthy, ML.The science of surge. Acad Emerg Med. 2006;13:1089–1094.Google Scholar
8.Kelen, GD, Kraus, C, McCarthy, ML, et alInpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368:1984–1990.Google Scholar
9.Kraus, CK, Levy, F, Kelen, GD.Lifeboat ethics: considerations in the discharge of inpatients for the creation of hospital surge capacity. Disaster Med Public Health Preparedness. 2007;1:51–56.CrossRefGoogle ScholarPubMed
10.Stratton, SJ, Tyler, RD.Characteristics of medical surge capacity demand for sudden-impact disasters. Acad Emerg Med. 2006;13:1193–1197.Google Scholar
11.Schull, MJ, Stukel, TA, Vermeulen, MJ, et alEffect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome. CMAJ. 2007;176:1827–1832.Google Scholar
12.Health, United States, 2007: With Chartbook on Trends in the Health of Americans Including Spreadsheets and Charts. DHHS publication no. (PHS) 2007-1232. Hyattsville, MD: National Center for Health Statistics; 2007.Google Scholar
13.Centers for Disease Control and Prevention. National Health Statistics Report: 2006 National Hospital Discharge Survey. Atlanta: CDC; 2008: pp. 1–20.Google Scholar
14.Hick, JL, O’Laughlin, DT.Concept of operations of triage of mechanical ventilation in an epidemic. Acad Emerg Med. 2006;13:223–229.CrossRefGoogle Scholar
15.Powell, T, Christ, KC, Birkhead, GS.Allocation of ventilators in a public health disaster. Disaster Med Public Health Preparedness. 2008;2:20–26.CrossRefGoogle Scholar
16.Devereaux, AV, Christian, MD, Sandrock, CE, et alDefinitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Chest. 2008;133:51S–66S.Google Scholar
17.Davis, DP, Poste, JC, Hicks, T, et alHospital bed surge capacity in the event of a mass-casualty incident. Prehosp Disaster Med. 2005;20:169–176.Google Scholar
18.Challen, K, Walter, D.Accelerated discharge of patients in the event of a major incident: observational study of a teaching hospital. BMC Public Health. 2006;6:108.Google Scholar
19.Shepperd, S, Doll, H, Agnus, RM, et alAdmission avoidance hospital at home. Cochrane Database Syst Rev. 2005;20:CD000356.Google Scholar
20.Joint Commission on Accreditation of Healthcare Organizations. Surge Hospitals: Providing Safe Care in Emergencies. 2006. http://www.jointcommission.org/NR/rdonlyres/802E9DA4-AE80-4584-A205-48989C5BD684/0/surge_hospital.pdf. Accessed March 19, 2009.Google Scholar
21.Department of Defense Policy for Prioritizing Delivery of Medical Care During Pandemics and Other Public Health Emergencies of National Significance. HA Policy 08-110, September 1, 2008. http://mhs.osd.mil/Content/docs/pdfs/policies/2008/08-010.pdf. Accessed March 19, 2009.Google Scholar
22.Altered Standards of Care in Mass Casualty Events. AHRQ publication no. 05-0043. Rockville, MD: Agency for Health Care Research and Quality; 2005.Google Scholar
23.Kanter, RK, Moran, JR.Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care. Pediatrics. 2007;119:94–100.Google Scholar
24.Tsai, MC, Arnold, JL, Chuang, CC, Chi, CH, Liu, CC, Yang, YJ.Impact of an outbreak of severe acute respiratory syndrome on a hospital in Taiwan, ROC. Emerg Med J. 2004;21:311–316.Google Scholar
25.Salinas, C, Salinas, C, Kurata, J.The effects of the Northridge earthquake on the pattern of emergency department care. Am J Emerg Med. 1998;16:254–256.Google Scholar
26.Cushman, JG, Pachter, LH, Beaton, HL.Two New York City hospitals’ surgical response to the September 11, 2001, terrorist attack in New York City. J Trauma. 2003;54:147–155.Google Scholar
27.Cocanour, CS, Allen, SJ, Mazabob, J, et alLessons learned from the evacuation of an urban teaching hospital. Arch Surg. 2002;137:1141–1145.CrossRefGoogle ScholarPubMed
28.Schultz, CH, Koenig, KL, Lewis, RJ.Implications of hospital evacuation after the Northridge, California, earthquake. N Engl J Med. 2003;348:1349–1355.CrossRefGoogle ScholarPubMed
29.Fine, MJ, Auble, TE, Yealy, DM, et alA prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250.CrossRefGoogle ScholarPubMed
30.Le Gall, JR, Lemeshow, S, Saulnier, F.A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–2963.Google Scholar
31.Knaus, WA, Wagner, DP, Draper, EA, et alThe APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619–1636.Google Scholar
32.Agency for Healthcare Research and Quality. National Hospital Available Beds for Emergencies and Disasters (HAvBED) System. Final Report. December 2005. http://www.ahrq.gov/prep/havbed. Accessed December 10, 2008.Google Scholar
33.Traub, M, Bradt, DA, Joseph, AP.The surge capacity for people in emergencies (SCOPE) study in Australasian hospitals. Med J Aust. 2007;186:394–398.Google Scholar
34.Einav, S, Aharonson-Daniel, L, Weissman, C, Freund, HR, Peleg, K.In-hospital resource utilization during multiple casualty incidents. Ann Surg. 2006;243:533–540.CrossRefGoogle ScholarPubMed
35.Jordan, MH, Hollowed, KA, Turner, DG, Wang, DS, Jeng, JC.The Pentagon attack of September 11, 2001: a burn center’s experience. J Burn Care Rehabil. 2005;26:109–116.Google Scholar
36.Cairns, BA, Stiffler, A, Price, F, Peck, MD, Meyer, AA.Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion. J Burn Care Rehabil. 2005;26:144–150.Google Scholar