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

Published online by Cambridge University Press:  28 June 2012

Daniel P. Davis ,
Jennifer C. Poste ,
Toni Hicks ,
Deanna Polk ,
Thérèse E. Rymer  and
Irving Jacoby
Daniel P. Davis*
Affiliation:
University of California-San Diego (UCSD)Department of Emergency Medicine, La Jolla, California UCSD School of Medicine, La Jolla, California
Jennifer C. Poste
Affiliation:
John Muir College, University of California-San Diego, La Jolla, California
Toni Hicks
Affiliation:
Sharp Healthcare, San Diego, California DMAT San Diego California-4
Deanna Polk
Affiliation:
Scripps Memorial Hospital, La Jolla, California DMAT San Diego California-4
Thérèse E. Rymer
Affiliation:
DMAT San Diego California-4 UCSD Medical Center, Office of Emergency Preparedness and Response, San Diego, California
Irving Jacoby
Affiliation:
University of California-San Diego (UCSD)Department of Emergency Medicine, La Jolla, California UCSD School of Medicine, La Jolla, California DMAT San Diego California-4
*
UCSD Emergency Medicine200 West Arbor Drive #8676San Diego, CA 92103USA E-mail: davismd@cox.net
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Abstract

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Introduction:

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.

Keywords

admissionsdischarge (hospital)hospitalnurse managerson-site nursing facilitypatient dispositionphysicianssurge capacity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 3 , June 2005 , pp. 169 - 176
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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