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Agency for Healthcare Research Quality

Public Health Preparedness

Common definitions and reverse triage can help hospital planners meet surge capacity demands during emergencies

Surge capacity is a health care system's ability to expand quickly beyond normal services to meet an increased demand for medical care during a large-scale public health emergency. Hospitals are expected to be able to operate with no outside help for up to 4 days during an emergency. Two new studies, funded in part by the Agency for Healthcare Research and Quality (HS14533) and summarized here, explore concepts associated with surge capacity. The first offers a taxonomy that refines definitions to assist planners both in preparing for emergencies and collecting data. The second explains how reverse triage can make beds available to meet peak demands during crises.

Hick, J.L., Barbera, J.A., and Kelen, G.D. (2009, June). "Refining surge capacity: Conventional, contingency, and crisis capacity." Disaster Medicine and Public Health Preparedness 3(Suppl 1), pp. S59-S67.

Noting the lack of definitions common to surge capacity, the authors developed a taxonomy that details space, staffing, and supply requirements during three levels of surge capacity. Conventional capacity is used to describe normal operations, contingency capacity is out-of-the ordinary demand that only minimally affects patient care, and crisis capacity requires adapting resources to provide care during an emergency. Common terminology not only permits hospitals to collect data consistently, it also creates a framework for developing aids, like worksheets, that may help staff members whose hospitals are called upon to increase capacity quickly. The authors stress that well-thought-out plans and system components, including command, control, communication, continuity of operations, and community infrastructure, are all vital for ensuring a hospital can properly respond to public health emergencies.

Kelen, G.D., McCarthy, M.L., Kraus, C.K., and others (2009, June). "Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events." Disaster Medicine and Public Health Preparedness 3(Suppl 1), pp. S1-S7.

Hospitals may be able to provide extra patient beds during a public health emergency by using reverse triage. This method evaluates inpatients to see which ones can be safely discharged to free up beds for other patients in more immediate need of medical care. Researchers studied the records of 3,491 inpatients at 3 Maryland hospitals to determine how many patients required critical interventions (CIs), such as major surgery, airway management, cardiopulmonary resuscitation, or intravenous medication, which would preclude discharge during an emergency. Those who did not require CIs could be discharged if their beds were needed, the researchers theorized. Forty-four percent of patients needed no CIs, and 40, 47, and 59 percent of patients from the three respective hospitals could have been safely discharged to meet surge demands. If these patient beds were made available during an emergency, gross surge capacity ranged from 77 to 103 percent for the three hospitals. Patient beds could have been available within 24 to 48 hours. The authors suggest that a system that predicts risks of CIs could be incorporated into the Hospital Available Beds for Emergencies and Disasters (HAvBED) System. Funded by the Agency for Healthcare Research and Quality, the HAvBED system is a national real-time hospital-bed tracking system being developed to address patient surge during a mass casualty event.

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