Use of “Shuttered” Hospitals to Expand Surge Capacity

2008 ◽  
Vol 23 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Richard D. Zane ◽  
Paul Biddinger ◽  
Lyndsley Ide ◽  
Sally Phillips ◽  
Donna Hurd ◽  
...  
Keyword(s):  
Urban Areas ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Weapons Of Mass Destruction ◽  
Mass Destruction ◽  
Careful Planning ◽  
Surge Capacity ◽  
Structural Deterioration ◽  
Ambulatory Patients ◽  
Isolation Facility

AbstractIntroduction:With limited available hospital beds in most urban areas, there are very few options when trying to relocate patients already within the hospital to make room for incoming patients from a mass-casualty incident (MCI) or epidemic (a patient surge). This study investigates the possibility and process for utilizing shuttered (closed or former) hospitals to accept medically stable, ambulatory patients transferred from a tertiary medical facility.Methods:Two recently closed, acute care hospitals were evaluated critically to determine if they could be made ready to accept inpatients within 3–7 days of a MCI. This surge facility ideally would be able to support 200–300 patients/beds. Two generic scenarios were used for planning: (1) a patient surge (including one caused by conventional war or terrorism, weapons of mass destruction, or a disaster caused by natural hazards) requiring transfer of ambulatory, medically-stable inpatients to another facility in an effort to increase capacity at existing hospitals; and (2) a bio-event or epidemic where a shuttered hospital could be used as an isolation facility.Results:Both recently closed hospitals had significant, but different challenges to reopening, although with careful planning and resource allocation it would be possible to reopen them within 3–7 days. Planning was the most conclusive recommendation. It does not appear possible to reopen shuttered hospitals with major structural deterioration or a complete lack of current mission (i.e., no current utilities). Staffing would represent the most challenging issue as a surge facility would represent an incremental additional need for existing and scarce human resources.Conclusions:With careful planning, a shuttered hospital could be reopened and ready to accept patients within 3–7 days of a MCI or epidemic.

scholarly journals Web-based, rapid and contactless management of ambulatory patients for SARS-CoV-2-testing

2020 ◽  
Author(s):  
Jannik Stemler ◽  
Oliver A. Cornely ◽  
Torsten Noack-Schönborn ◽  
Corinna Forholz ◽  
Sofie Schumacher ◽  
...  
Keyword(s):  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Test Results ◽  
Web Based ◽  
Duration Of Symptoms ◽  
Efficient Management ◽  
Ambulatory Patients ◽  
The University ◽  
Outpatient Appointments

Abstract BackgroundDuring the SARS-CoV-2 pandemic a mass casualty incident of ambulatory patients occurred at the COVID-19 rapid response infrastructure (CRRI) facility at the University Hospital of Cologne (UHC). We report the development of a patient-centred mobile-device solution to support efficient management of the facility, triage of patients and rapid delivery of test results.MethodsThe UHC-Corona Web Tool (CWT) was developed as a web-based application useable on each patient's smartphone. It provides, among others, a self-reported medical history including type and duration of symptoms and potential risk contacts and links all retrieved information to the digital patient chart via a QR code. It provides scheduling of outpatient appointments and automated transmission of SARS-CoV-2 test results.ResultsThe UHC-CWT was launched on April 9th, 2020. It was used by 28652 patients until August 31st,2020. Of those, 15245 (53,2%) consulted the CRRI, representing 43,1% of all CRRI patients during the observed period.There were 8304 (29,0%) specifications concerning travel history and 17145 (59,8%) indications of ≥1 symptom of SARS-CoV-2 infection. The most frequently indicated symptoms were sore throat (60,0%), headache (50,7%), common cold (45,1%) and cough (42,6%) while 11057 (40,2%) patients did not report any symptoms. After implementation of the UHC-CWT, the number of patient contacts per physician rose from 38 to 98,7 per day. The personnel for communication of test results was reduced from four on seven days to one on five days.ConclusionThe UHC-CWT is an effective digital solution for management of large numbers of outpatients for SARS-CoV-2 testing.

A Simple Graphical Method for Quantification of Disaster Management Surge Capacity Using Computer Simulation and Process-control Tools

2014 ◽  
Vol 30 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Jeffrey Michael Franc ◽  
Pier Luigi Ingrassia ◽  
Manuela Verde ◽  
Davide Colombo ◽  
Francesco Della Corte
Keyword(s):  
Computer Simulation ◽  
Process Control ◽  
Statistical Method ◽  
Disaster Management ◽  
Graphical Method ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Patient Volume ◽  
Statistical Tools ◽  
Surge Capacity

AbstractIntroductionSurge capacity, or the ability to manage an extraordinary volume of patients, is fundamental for hospital management of mass-casualty incidents. However, quantification of surge capacity is difficult and no universal standard for its measurement has emerged, nor has a standardized statistical method been advocated. As mass-casualty incidents are rare, simulation may represent a viable alternative to measure surge capacity.Hypothesis/ProblemThe objective of the current study was to develop a statistical method for the quantification of surge capacity using a combination of computer simulation and simple process-control statistical tools. Length-of-stay (LOS) and patient volume (PV) were used as metrics. The use of this method was then demonstrated on a subsequent computer simulation of an emergency department (ED) response to a mass-casualty incident.MethodsIn the derivation phase, 357 participants in five countries performed 62 computer simulations of an ED response to a mass-casualty incident. Benchmarks for ED response were derived from these simulations, including LOS and PV metrics for triage, bed assignment, physician assessment, and disposition. In the application phase, 13 students of the European Master in Disaster Medicine (EMDM) program completed the same simulation scenario, and the results were compared to the standards obtained in the derivation phase.ResultsPatient-volume metrics included number of patients to be triaged, assigned to rooms, assessed by a physician, and disposed. Length-of-stay metrics included median time to triage, room assignment, physician assessment, and disposition. Simple graphical methods were used to compare the application phase group to the derived benchmarks using process-control statistical tools. The group in the application phase failed to meet the indicated standard for LOS from admission to disposition decision.ConclusionsThis study demonstrates how simulation software can be used to derive values for objective benchmarks of ED surge capacity using PV and LOS metrics. These objective metrics can then be applied to other simulation groups using simple graphical process-control tools to provide a numeric measure of surge capacity. Repeated use in simulations of actual EDs may represent a potential means of objectively quantifying disaster management surge capacity. It is hoped that the described statistical method, which is simple and reusable, will be useful for investigators in this field to apply to their own research.FrancJM, IngrassiaPL, VerdeM, ColomboD, Della CorteF. A simple graphical method for quantification of disaster management surge capacity using computer simulation and process-control tools. Prehosp Disaster Med. 2015;30(1):1-7.

Hospital Bed Surge Capacity in the Event of a Mass-Casualty Incident

2005 ◽  
Vol 20 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Daniel P. Davis ◽  
Jennifer C. Poste ◽  
Toni Hicks ◽  
Deanna Polk ◽  
Thérèse E. Rymer ◽  
...  
Keyword(s):  
Nurse Managers ◽  
Census Data ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Nurse Manager ◽  
Admission Diagnosis ◽  
Cross Sectional ◽  
Nursing Facility ◽  
Surge Capacity ◽  
Hospital Bed

AbstractIntroduction:Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualtyincident.Objective:To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities.Methods:Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient.Results:A total of 1,741 assessments of 788 patients by 82 nurse managers aabnd 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than werenurse managers to send patients to such a facility or discharge them, but less likely to transfer patients outof the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses.Conclusions:A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.

Rapid Patient Discharge Contribution to Bed Surge Capacity During a Mass Casualty Incident

2018 ◽  
Vol 27 (1) ◽  
pp. 24-29
Author(s):  
Jasmine L. Jacobs-Wingo ◽  
Heather A. Cook ◽  
William H. Lang
Keyword(s):  
Patient Discharge ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Surge Capacity

Principles of Emergency Department Facility Design for Optimal Management of Mass-Casualty Incidents

2012 ◽  
Vol 27 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Pinchas Halpern ◽  
Scott A. Goldberg ◽  
Jimmy G. Keng ◽  
Kristi L. Koenig
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Optimal Management ◽  
Facility Design ◽  
Surge Capacity ◽  
Efficient Management ◽  
Structural Principles

AbstractIntroductionThe Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center.ReportIn the authors’ experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services.DiscussionDesigning the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED.ConclusionThis study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and staff safety.Halpern P, Goldberg SA, Keng JG, Koenig KL. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.Prehosp Disaster Med.2012;27(2):1-9.

Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity

2009 ◽  
Vol 3 (S1) ◽  
pp. S59-S67 ◽  
Author(s):  
John L. Hick ◽  
Joseph A. Barbera ◽  
Gabor D. Kelen
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Standard Of Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Health Care Facilities ◽  
Surge Capacity ◽  
Care Facilities

ABSTRACTHealth care facility surge capacity has received significant planning attention recently, but there is no commonly accepted framework for detailed, phased surge capacity categorization and implementation. This article proposes a taxonomy within surge capacity of conventional capacity (implemented in major mass casualty incidents and representing care as usually provided at the institution), contingency capacity (using adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on delivered medical care), and crisis capacity (implemented in catastrophic situations with a significant impact on standard of care). Suggested measurements used to gauge a quantifiable component of surge capacity and adaptive strategies for staff and supply challenges are proposed. The use of refined definitions of surge capacity as it relates to space, staffing, and supply concerns during a mass casualty incident may aid phased implementation of surge capacity plans at health care facilities and enhance the consistency of terminology and data collection between facilities and regions. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S59–S67)

scholarly journals Disaster Preparedness and Management in Pakistan: A Systematic Review

2019 ◽  
Vol 34 (s1) ◽  
pp. s122-s122 ◽  
Author(s):  
Sana Shahbaz
Keyword(s):  
Disaster Management ◽  
Disaster Preparedness ◽  
Urban Areas ◽  
Hospital Management ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Shootings ◽  
Politically Motivated Violence ◽  
Almost All ◽  
Hospital Disaster Preparedness

Introduction:Since its inception about 66 years ago, Pakistan has experienced a variety of both natural and man-made disasters like earthquakes in 2005 and 2015 and widespread flooding in 2010. Pakistan has also experienced a range of politically motivated violence, bombings in urban areas, as well as mass shootings. Such events generate a large number of casualties. To minimize the loss of life, well-coordinated prehospital and in-hospital response to disasters is required.Aim:To identify all the existing peer-reviewed medical literature on prehospital and in-hospital disaster preparedness and management in Pakistan.Methods:The search was conducted using PubMed and Hollis plus search engines in accordance with the PRISMA guidelines. The articles selected included articles on both natural and man-made disasters, and their subsequent prehospital and in hospital management. The following search terms and keywords were used while searching PubMed: mass casualty incident preparedness and management Karachi, mass casualty incident preparedness, disaster preparedness Karachi, and disaster management Karachi. To search Hollis plus, we used the terms: mass casualty incident preparedness and management Pakistan, mass casualty incident Pakistan, mass casualty incident preparedness and management Karachi, and disaster preparedness Karachi. We selected only peer-reviewed articles for a literature search and review.Results:The reviewed articles show a lack of data regarding disaster management in Pakistan. Almost all the articles unanimously state the scarcity of planned prehospital and in-hospital management related to both man-made as well as natural disasters. There is a need for planned and coordinated efforts for disaster management in Pakistan.

Public Health Response Actions and the Use of Emergency Operations Centers

2003 ◽  
Vol 18 (3) ◽  
pp. 217-219 ◽  
Author(s):  
A. Thomas Mignone ◽  
Robert Davidson
Keyword(s):  
Public Health ◽  
New York ◽  
Mass Casualty ◽  
Weapons Of Mass Destruction ◽  
Mass Casualties ◽  
Mass Destruction ◽  
Public Health Response ◽  
Emergency Operations ◽  
Incident Command ◽  
Health Response

AbstractIn the wake of 11 September 2001, many public health agencies are reassessing their institutional capabilities and procedures to respond to mass-casualty incidents involving weapons of mass destruction. Prior to the fall of 2001, planning by the public health and other sectors addressed more conventional or naturally occurring events such as earthquakes, hurricanes, tornados, and chemical spills, although attacks with weapons of mass destruction were a growing concern. While the nature of natural versus intentional events differs, the management and coordination of response activities to them follows the same incident command system.A major lesson learned during the response operations to the 11 September 2001 attacks in New York City was the value of disaster planning, conducting exercises, and developing relationships among the various response agencies. Although New York City's physical Emergency Operations Center (EOC) at 7 World Trade Center was destroyed in the attack, the medical and health response community was able to react effectively to the possibility of mass casualties as well as to the more usual needs. This was enabled by the pre-existing relationships that had been developed between city, state, federal, and non-governmental agencies while planning and exercising for such events and their aftermaths.

scholarly journals Strategies for Improved Hospital Response to Mass Casualty Incidents

2018 ◽  
Vol 12 (6) ◽  
pp. 778-790 ◽  
Author(s):  
Mersedeh TariVerdi ◽  
Elise Miller-Hooks ◽  
Thomas Kirsch
Keyword(s):  
Urban Areas ◽  
Demand Management ◽  
Capacity Expansion ◽  
Service Level ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Urban Hospital ◽  
Medical Needs ◽  
Expansion Strategies

AbstractMass casualty incidents are a concern in many urban areas. A community’s ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital’s capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;12:778-790)

scholarly journals Web-based, rapid and contactless management of ambulatory patients for SARS-CoV-2-testing

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jannik Stemler ◽  
Oliver A. Cornely ◽  
Torsten Noack-Schönborn ◽  
Corinna Fohrholz ◽  
Sofie Schumacher ◽  
...  
Keyword(s):  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Test Results ◽  
Web Based ◽  
Duration Of Symptoms ◽  
Efficient Management ◽  
Ambulatory Patients ◽  
The University ◽  
Outpatient Appointments

Abstract Background During the SARS-CoV-2 pandemic a mass casualty incident of ambulatory patients occurred at the COVID-19 rapid response infrastructure (CRRI) facility at the University Hospital of Cologne (UHC). We report the development of a patient-centred mobile-device solution to support efficient management of the facility, triage of patients and rapid delivery of test results. Methods The UHC-Corona Web Tool (CWT) was developed as a web-based software useable on each patient’s smartphone. It provides, among others, a self-reported medical history including type and duration of symptoms and potential risk contacts and links all retrieved information to the digital patient chart via a QR code. It provides scheduling of outpatient appointments and automated transmission of SARS-CoV-2 test results. Results The UHC-CWT was launched on 9 April 2020. It was used by 28,652 patients until 31 August 2020. Of those, 15,245 (53,2%) consulted the CRRI, representing 43,1% of all CRRI patients during the observed period. There were 8304 (29,0%) specifications concerning travel history and 17,145 (59,8%) indications of ≥1 symptom of SARS-CoV-2 infection. The most frequently indicated symptoms were sore throat (60,0%), headache (50,7%), common cold (45,1%) and cough (42,6%) while 11,057 (40,2%) patients did not report any symptoms. After implementation of the UHC-CWT, the amount of patient contacts per physician rose from 38 to 98,7 per day. The personnel for communication of test results were reduced from four on seven days to one on five days. Conclusion The UHC-CWT is an effective digital solution for management of large numbers of outpatients for SARS-CoV-2 testing.

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