State of research in high-consequence hospital surge capacity
State of research in high-consequence hospital surge capacity
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DOI：
10.1197/j.aem.2006.06.033
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发表时间：
2006-11-01
影响因子：
4.4
通讯作者：
Koenig, Kristi L.
中科院分区：
文献类型：
--
作者：
Schultz, Carl H.;Koenig, Kristi L.
高后果激增的研究涉及一个系统的方法，包括要素，如医疗设施，医院外系统，太平间服务，公共卫生和庇护。本文重点介绍了这项研究的一个方面，医院激增的能力，并讨论了这种能力的定义，它的组成部分，以及未来的考虑。虽然存在快速部署能力的概念定义，但需要加强以证据为基础的医院实用指南。卫生资源和服务管理局（HRSA）的定义和基准是从其他国家的定义和基准中推断出来的，主要依赖于创伤数据。HRSA目标中最重要的部分，即需要在24小时内照顾每百万人口中500名感染传染病的受害者，并不是使用生物模型开发的。如果HRSA的建议适用于一个样本大都市地区，如加州的橙子县，这意味着在最初的24小时内将医院容量扩大20%-25%。支持这一目标的文献主要是基于共识或轶事。目前没有客观的衡量标准来界定医院的快速增援能力。确定快速部署能力组成部分的文献相当一致，将其列为人员、用品和设备、设施和管理系统。目前还没有研究确定医院加强这些组成部分的战略，也没有估计需要多长时间。一个增加医院工作人员的系统，即志愿卫生专业人员预先登记紧急系统，是一个从未经过测试的共识计划。未来的挑战包括制定战略，以处理两种不同类型的高后果激增事件：1）集中的，有时间限制的事件（如地震），外部资源存在，可以调动，以帮助那些需要帮助的人和2）广泛的，长期的事件（如大流行性流感），所有的资源都将被使用，需要配给或分类。
High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on trauma data. The most significant part of the HRSA target, the need to care for 500 victims stricken with an infectious disease per one million population in 24 hours, was not developed using a biological model. If HRSA's recommendation is applied to a sample metropolitan area such as Orange County, California, this translates to a goal of expanding hospital capacity by 20%-25% in the first 24 hours. Literature supporting this target is largely consensus based or anecdotal. There are no current objective measures defining hospital surge capacity. The literature identifying the components of surge capacity is fairly consistent and lists them as personnel, supplies and equipment, facilities, and a management system. Studies identifying strategies for hospitals to enhance these components and estimates of how long it will take are lacking. One system for augmenting hospital staff, the Emergency System for Advance Registration of Volunteer Health Professionals, is a consensus-derived plan that has never been tested. Future challenges include developing strategies to handle the two different types of high-consequence surge events: 1) a focal, time-limited event (such as an earthquake) where outside resources exist and can be mobilized to assist those in need and 2) a widespread, prolonged event (such as pandemic influenza) where all resources will be in use and rationing or triage is needed.