Discharge Criteria for Creation of Hospital Surge Capac*

创建医院激增容量的出院标准*

• 批准号: 6783245
• 负责人: GABOR D KELEN
• 金额: $ 91.12万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2006-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6783245
• 关键词: bioterrorism /chemical warfare; clinical research; cooperative study; decision making; disasters; emergency care; emergency health services; gender difference; health care quality; health services research tag; hospital utilization; human subject; mathematical model; medical records; patient care management; primary care physician; racial /ethnic difference

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.

描述（由申请人提供）：自9/11以来，在重大影响（BT）或其他关键事件的重大影响（BT）或其他关键事件期间，突然的患者的突然体积的能力已成为新的重点。尽管以前的努力集中在院前分类和ED激增的能力上，并且最近专注于替代治疗地点，但现实是，至少最初医院将首当其冲地关心病人和受伤的人。此外，在BT事件中，住院容量可能会受到严格的限制，该事件需要隔离患者，从而闭合通常向普通患者开放的床/病房。因此，如果灾难需要建立医院涌现的能力，则需要开发一种可推广的，易于应用的方法来预先指定的住院患者。我们建议通过以下方式开发这样一个系统：（1）举行一项共识会议（各种各样的临床医生，灾难控制管理员，伦理学家，灾难管理专家，患者安全专家和具有疾病严重程度评分和决策工具经验的院士）来开发算法/标准的经验，而不是可以使患者的风险分层适合出院； （2）使用实时患者数据，在三个不同的医院环境（主要学术中心，附属教学医院，社区医院）中前瞻性测试，然后完善所得工具； （3）测试其 在执业医师手中的适用性，进行进一步的改进以及； （4）通过模拟演习，比较开发的工具能够识别被认为是安全出院安全的患者v。当前识别灾难后患者的临时方法。我们相信最后的可交付；预先指定的住院患者的一种可推广的，经过验证的方法将在美国医院中具有广泛的适用性，以便在BT或其他关键事件的情况下快速创造激增的能力。

项目成果

Lifeboat ethics: considerations in the discharge of inpatients for the creation of hospital surge capacity.

救生艇伦理：住院病人出院时的考虑因素，以建立医院增援能力。

• DOI: 10.1097/dmp.0b013e318065c4ca
• 发表时间: 2007
• 期刊: Disaster medicine and public health preparedness
• 影响因子: 2.7
• 作者: Kraus,ChaddK;Levy,Frederick;Kelen,GaborD
• 通讯作者: Kelen,GaborD

Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study.

• DOI: 10.1016/s0140-6736(06)69808-5
• 发表时间: 2006-12-02
• 期刊: Lancet (London, England)
• 作者: Kelen GD;Kraus CK;McCarthy ML;Bass E;Hsu EB;Li G;Scheulen JJ;Shahan JB;Brill JD;Green GB
• 通讯作者: Green GB