Cancellation of Scheduled Procedures as a Mechanism to Generate Hospital Bed Surge Capacity—A Pilot Study

Soremekun, Olan A.; Zane, Richard D.; Walls, Andrew C.; Allen, Matthew B.; Seefeld, Kimberly; Pallin, Daniel J.

doi:10.1017/s1049023x11006248

Cited by 22 publications

(15 citation statements)

References 13 publications

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“…Following abstract and article review for relevance, a total of 313 articles addressing surge and surge capacity remained. Following detailed text review, 50 quantitative and 11 concept papers (consensus conference recommendations) met all inclusion criteria (Tables A–E and Data Supplement S1, available as supporting information in the online version of this paper). Of the quantitative articles judged relevant, 31 articles focused on criteria and methods for decision‐making for scarce resource allocation, 16 were related to effective triage protocols, nine concerned key decision makers for surge‐capacity planning and evaluating response efficacy, seven addressed meeting workforce needs, and seven were related to developing communication and information‐sharing strategies.…”

Section: Resultsmentioning

confidence: 99%

“…The concept of Kelen et al for reverse triage may be one of the simplest, yet most practical and easily implemented of the proposed triage (or any type of surge) interventions, demonstrating that increases in surge capacity of 50% to 60% (of staffed hospital beds) may be achieved with relative ease, simply by following a strategy of selective early patient discharge and cancellation of elective procedures. Four prospective studies have lent credibility to this approach . Satterthwaite and Atkinson described the implementation of a reverse triage strategy during a disaster, quickly achieving 16% hospital capacity, almost double the Australian government expectation.…”

Section: Discussionmentioning

confidence: 99%

“…Van Cleve et al similarly achieved a 20% increase in bed capacity within 16 hours through a reverse triage strategy. However, Soremekun et al achieved only a modest 7.5% increase in bed capacity with a single scope reverse triage strategy (delay of procedures). Stukel et al achieved additional surge capacity through reverse triage (among other strategies), by restriction of inpatient admissions during a declared “surge” period for severe acute respiratory syndrome (SARS) in Toronto.…”

Section: Discussionmentioning

confidence: 99%

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Developments in Surge Research Priorities: A Systematic Review of the Literature Following the Academic Emergency Medicine Consensus Conference, 2007–2015

Morton

DeAugustinis

Velasquez

et al. 2015

Academic Emergency Medicine

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Objectives: In 2006, Academic Emergency Medicine (AEM) published a special issue summarizing the proceedings of the AEM consensus conference on the "Science of Surge." One major goal of the conference was to establish research priorities in the field of "disasters" surge. For this review, we wished to determine the progress toward the conference's identified research priorities: 1) defining criteria and methods for allocation of scarce resources, 2) identifying effective triage protocols, 3) determining decision-makers and means to evaluate response efficacy, 4) developing communication and information sharing strategies, and 5) identifying methods for evaluating workforce needs.Methods: Specific criteria were developed in conjunction with library search experts. PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases were queried for peer-reviewed articles from 2007 to 2015 addressing scientific advances related to the above five research priorities identified by AEM consensus conference. Abstracts and foreign language articles were excluded. Only articles with quantitative data on predefined outcomes were included; consensus panel recommendations on the above priorities were also included for the purposes of this review. Included study designs were randomized controlled trials, prospective, retrospective, qualitative (consensus panel), observational, cohort, case-control, or controlled before-and-after studies. Quality assessment was performed using a standardized tool for quantitative studies.Results: Of the 2,484 unique articles identified by the search strategy, 313 articles appeared to be related to disaster surge. Following detailed text review, 50 articles with quantitative data and 11 concept papers (consensus conference recommendations) addressed at least one AEM consensus conference surge research priority. Outcomes included validation of the benchmark of 500 beds/million of population for disaster surge capacity, effectiveness of simulation-and Internet-based tools for forecasting of hospital and regional demand during disasters, effectiveness of reverse triage approaches, development of new disaster surge metrics, validation of mass critical care approaches (altered standards of care), use of telemedicine, and predictions of optimal hospital staffing levels for disaster surge events. Simulation tools appeared to provide some of the highest quality research.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Developments in Surge Research Priorities: A Systematic Review of the Literature Following the Academic Emergency Medicine Consensus Conference, 2007–2015

Morton

DeAugustinis

Velasquez

et al. 2015

Academic Emergency Medicine

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“…Because of these limitations, using existing hospital spaces and ventilation systems to establish a surge ward could be an improvement on previous negative-pressure isolation ward designs. Supplemental methods to increase surge capacity, such as reverse triage, 29 reducing nonurgent hospital admissions, 12 and delaying certain types of surgery, 30 could provide the room availability needed to establish a surge ward in a functioning hospital.…”

Section: Discussionmentioning

confidence: 99%

Implementing a negative-pressure isolation ward for a surge in airborne infectious patients

Miller

Clements

Elliott

et al. 2017

American Journal of Infection Control

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“…Our findings also suggest the need to respond acutely to perturbations in ICU bed availability, particularly accounting for MICU bed availability. During times of increased critical care strain, a flexible, system wide process may help to meet unpredictable surges in critical care demand (25) (26) (27) (28). In addition, the implementation of previously described quality improvement practices to reduce ICU length of stay may increase the number of available beds (29) (30) (31).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between ICU Bed Availability, ICU Readmission, and Cardiac Arrest in the General Wards

Town

Churpek

Yuen

et al. 2014

Critical Care Medicine

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Objective The decision to admit a patient to the intensive care unit (ICU) is complex, reflecting patient factors and available resources. Previous work has shown that ICU census does not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is unknown. We sought to determine the association between ICU bed availability, ICU readmissions, and ward cardiac arrests. Design In this observational study using data collected between 2009 and 2011, rates of ICU readmission and ward cardiac arrest were determined per 12-hour shift. The relationship between these rates and the number of available ICU beds at the start of each shift (accounting for census and nursing capacity), were investigated. Grouped logistic regression was used to adjust for potential confounders. Setting Five specialized adult ICUs comprising 63 adult ICU beds in an academic medical center. Patients Any patient admitted to a non-ICU inpatient unit was counted in the ward census and considered at risk for ward cardiac arrest. Patients discharged from an ICU were considered at risk for ICU readmission. Measurements and Main Results Data were available for 2086 of 2190 shifts. The odds of ICU readmission increased with each decrease in the overall number of available ICU beds (OR=1.06 [95% CI, 1.00–1.12], p=0.03), with a similar but not statistically significant association demonstrated in ward cardiac arrest rate (OR= 1.06 [95% CI, 0.98–1.14], p=0.16). In subgroup analysis, the odds of ward cardiac arrest increased with each decrease in the number of medical ICU beds available (OR= 1.26 [95% CI, 1.06–1.49], p=0.01). Conclusions Reduced ICU bed availability is associated with increased rates of ICU readmission and ward cardiac arrest. This suggests that systemic factors are associated with patient outcomes and flexible critical care resources may be needed when demand is high.

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Cancellation of Scheduled Procedures as a Mechanism to Generate Hospital Bed Surge Capacity—A Pilot Study

Cited by 22 publications

References 13 publications

Developments in Surge Research Priorities: A Systematic Review of the Literature Following the Academic Emergency Medicine Consensus Conference, 2007–2015

Developments in Surge Research Priorities: A Systematic Review of the Literature Following the Academic Emergency Medicine Consensus Conference, 2007–2015

Implementing a negative-pressure isolation ward for a surge in airborne infectious patients

Relationship Between ICU Bed Availability, ICU Readmission, and Cardiac Arrest in the General Wards

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