Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events
Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events
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DOI：
10.1097/dmp.0b013e3181a5e7cd
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发表时间：
2009-06-01
影响因子：
2.7
通讯作者：
Green, Gary B.
中科院分区：
文献类型：
--
作者：
Kelen, Gabor D.;McCarthy, Melissa L.;Green, Gary B.
目的：美国医院预计在灾难期间可以在没有外部援助的情况下运作长达96小时;然而，人们担心医院没有足够的能力来吸收大量的急性伤员。该研究的目的是确定从早期出院创造住院床位激增能力的潜力（反向分诊）的医院住院病人在低风险的不良事件长达96小时。在具有3家代表美国机构的容量受限医院的卫生系统中（学术，教学附属机构，社区），各种（N = 50）住院单位进行了前瞻性调查，在旋转使用区组随机设计，为期19周，结束于2006年2月。重症监护室（ICU）、托儿所和儿科病房被排除在外。假设灾难发生在登记的当天，不需要任何（先前定义的）关键干预4天的患者被认为适合提前出院。结果：3491例患者中，44%不需要任何关键干预，适合提前出院。考虑到额外的常规病人出院，充分利用有工作人员和无工作人员的许可床位，3家医院的总激增能力估计为77%、95%和103%。考虑到非受害者紧急入院的可能持续性，可用于灾害受害者的净激增能力估计分别为66%，71%和81%。逆向分诊占缓冲床的大多数（50%，55%，59%）。大多数实现的能力是在24至48 hours.Conclusions：医院的标准住院床位激增的能力可能比以前认为的更大。反向分流如果得到适当利用，可以成为快速部署能力的主要贡献者。（公共卫生应急预案。2009; 3（增刊1）：S10-S16）
Objectives: US hospitals are expected to function without external aid for up to 96 hours during a disaster; however, concern exists that there is insufficient capacity in hospitals to absorb large numbers of acute casualties. The aim of the study was to determine the potential for creation of inpatient bed surge capacity from the early discharge ( reverse triage) of hospital inpatients at low risk of untoward events for up to 96 hours.Methods: In a health system with 3 capacity-constrained hospitals that are representative of US facilities ( academic, teaching affiliate, community), a variety (N = 50) of inpatient units were prospectively canvassed in rotation using a blocked randomized design for 19 weeks ending in February 2006. Intensive care units (ICUs), nurseries, and pediatric units were excluded. Assuming a disaster occurred on the day of enrollment, patients who did not require any ( previously defined) critical intervention for 4 days were deemed suitable for early discharge.Results: Of 3491 patients, 44% did not require any critical intervention and were suitable for early discharge. Accounting for additional routine patient discharges, full use of staffed and unstaffed licensed beds, gross surge capacity was estimated at 77%, 95%, and 103% for the 3 hospitals. Factoring likely continuance of nonvictim emergency admissions, net surge capacity available for disaster victims was estimated at 66%, 71%, and 81%, respectively. Reverse triage made up the majority (50%, 55%, 59%) of surge beds. Most realized capacity was available within 24 to 48 hours.Conclusions: Hospital surge capacity for standard inpatient beds may be greater than previously believed. Reverse triage, if appropriately harnessed, can be a major contributor to surge capacity. ( Disaster Med Public Health Preparedness. 2009; 3(Suppl 1): S10-S16)