Surge Capacity Toolkit for Hospitals

1. Surge Capacity Toolkitfor Hospitals William Lang Administrative Consultant Bioterrorism Hospital Preparedness Program, NYC DOHMH Contact Information: Tel. 914-262-5675 Email: wlangconsult@yahoo.com

2. NYC DOHMH2007 Core Deliverables – C.1 & C.2 Submit a site-specific plan for increasing bed capacityHospitals will be asked to: • Incorporate surge capacity tools and templates provided by DOHMH BHPP. • Review and incorporate previously prepared protocols, lessons learned from after action reports, and results of hospital assessments into their plan. • Participate in a BHPP-sponsored workshop (also known as “Surge Clinics”). • Submit Plans to DOHMH.

3. Tool Development Objectives • Flexible/adaptable to the needs of participating hospitals • Include recommendations and best practices from “Surge Clinics” • Consistent formatting • Easily understood • Easy to use

4. Hospital Surge Categories

5. Surge Beds – Related Activities

6. Surge Beds – Groups of Activities

7. Surge – Bed Yielding Activities

8. UCSD Discharge Study, 2005 To determine how many acute care beds could be made available in the event of a mass casualty incident. • 4 Hospitals • 1741 Assessments • 788 Patients • 82 Nurse Manager • 25 Physicians Hospital Bed Surge Capacity in the Event of a Mass-Casualty Incident; Davis, Poste, Hicks, Polk, Rhymer, Jacoby; May-June 2005; Prehospital and Disaster Medicine.

9. UCSD Discharge Study, 2005 Findings • 33% of the patients were assessed as dischargeable at 24 hours; 50% at 72 hours. Conclusion • Rapid discharge will be an efficient early intervention to increase bed capacity, Hospital Bed Surge Capacity in the Event of a Mass-Casualty Incident; Davis, Poste, Hicks, Polk, Rhymer, Jacoby; May-June 2005; Prehospital and Disaster Medicine.

10. Toolkit Features & Benefits • Provides activity definitions, descriptions, outcomes, team members, estimated time to implement, and bed yield potential. • Lessens reliance on “off-the-cuff” solutions. • Assures all appropriate actions are engaged. • Encourages planning involvement of subject matter experts.

11. Toolkit Features & Benefits \ Cont… • Helps to assure regulatory compliance with discharge practices. • Tools can be used by subject matter experts and non-experts alike. • Can be used in tight bedding situations - not just in emergencies. • Decreases length of stay!

12. Tool Development – Timeline(2006) • Nov 06: GNYHA • Nov 16: DOHMH forms Surge Capacity Workgroup • Nov 30: DOHMH Materials distributed to Hospitals (Rapid Discharge Tool, Beds Planning Committee guidance document) • Nov-Dec: Hospitals form Beds Planning Committees

13. Tool Development – Timeline(2007) • Jan 17: DOHMH Materials distributed to Hospitals (Capacity Expansion tools) • Jan: Hospitals begin work on Draft Surge Plans. • Feb: Hospitals attend Surge Clinics (one-day), sponsored by DOHMH • Mar: Hospitals submit Draft Plans to DOHMH

14. Where to Begin? • Begin to assess current discharge practices in your own institutions by asking: • Who are the key individuals involved in the discharge process? • Do you have unit-based discharge teams? • Do you have length-of-stay teams? • Do you have an “Intend to Discharge Form”?If so, how is it used? • Do you have policies and procedures governing patient discharge?

15. Summary & Conclusion • FY 2006 Core Deliverables C.1 & C.2 - submit plans for increasing bed capacity. • DOHMH provides rapid discharge and capacity expansion tools and templates. • Hospitals review and submit to DOHMH materials comprising practices related to bed surge capacity. • Hospitals participate in “Surge Clinics” to adapt best practices and recommendations to their own plans. • Hospitals submit Draft & Final plans to the DOHMH.

16. William Lang Administrative Consultant Bioterrorism Hospital Preparedness Program, NYC DOHMH Contact Information: Tel. 914-262-5675 Email: wlangconsult@yahoo.com