Discharge Criteria for Creation of Hospital Surge Capac*

描述（由申请人提供）：自9/11以来，在重大影响生物威胁（BT）或其他重大事件期间护理突然大量患者的能力获得了新的关注。虽然以前的努力集中在院前分诊和艾德激增的能力，最近的重点是替代治疗地点，但现实是，至少在最初，医院将首当其冲地照顾病人和受伤者。此外，在BT事件期间，住院能力可能会受到严重限制，需要隔离患者，从而关闭通常对普通患者开放的病床/病房。因此，有必要开发一种可推广的、易于应用的方法，以便在灾难需要建立医院增援能力时，预先指定适合提前出院的住院患者。我们建议通过以下方式建立这样一个系统：（1）举行专家协商会议（各种临床医生、灾难控制管理员、伦理学家、灾难管理专家、患者安全专家以及在疾病严重程度评分和决策工具方面具有经验的学者）开发一套算法/标准，以便对适合出院的患者进行风险分层;（2）使用真实的时间患者数据，在三个不同的医院设置（主要学术中心、附属教学医院、社区医院）中前瞻性地测试并随后改进所得到的工具;（3）测试其 在执业医师手中的适用性，做进一步的改进，和（4）通过模拟演习，比较开发的工具的能力，以确定被认为是安全的患者提前出院与目前的特设方法，确定患者灾难后宣布。我们相信，最终的交付成果，一个可推广的，经过验证的方法，预先指定住院患者的安全早期出院，将有广泛的适用性，在全国的医院快速创建激增能力，在发生BT或其他关键事件。

DESCRIPTION (PROVIDED BY APPLICANT): The ability to care for a sudden volume of patients during a significant impact biothreat (BT) or other Critical Event has gained new focus since 9/11. While previous efforts have concentrated on pre-hospital triage and ED surge capacity and more recently focus on alternate treatment sites, the reality is that at least initially hospitals will bare the brunt of caring for the sick and injured. Further, inpatient capacity may become severely constrained during a BT event that requires isolation of patients and thus closure of beds/wards normally open to general patients. Thus, there is a need to develop a generalizable, easy to apply method to pre-designate hospitalized patients suitable for early discharge should a disaster require the creation of hospital surge capacity. We propose to develop such a system by: (1) holding a consensus conference of experts (wide variety of clinicians, disaster control administrators, ethicists, experts in disaster management, patient safety, and academicians with experience in illness severity scoring and decision making tools) to develop an algorithm/criteria set than can risk stratify patients suitable for discharge; (2) using real time patient data, in three different hospital settings (major academic center, affiliated teaching hospital, community hospital) prospectively test and subsequently refine the resultant tool; (3) test its applicability in the hands of practicing physicians, making further refinements, and; (4) via a simulated drill, compare the developed tool's ability to identify patients considered safe for early discharge v. the current ad hoc method of identifying patients post disaster announcement. We believe the final deliverable; a generalizable, validated method to pre-designate hospitalized patients for safe early discharge will have wide applicability in the nation's hospitals for the rapid creation of surge capacity in the event of a BT or other critical event.