Discharge Criteria for Creation of Hospital Surge Capac*

描述(由申请人提供)：自9/11事件以来，在重大影响生物治疗(BT)或其他危急事件期间照顾突如其来的大量患者的能力获得了新的关注。虽然之前的努力集中在院前分诊和急诊室的激增能力，最近又专注于替代治疗地点，但现实是，至少在一开始，医院将首当其冲地照顾病人和伤员。此外，在需要隔离患者的BT事件期间，住院能力可能会受到严重限制，从而关闭通常对普通患者开放的床位/病房。因此，需要开发一种通用的、易于应用的方法来预先指定住院患者，以便在灾难需要创建医院激增能力的情况下提前出院。我们建议通过以下方式开发这样一个系统：(1)召开一次专家共识会议(各种临床医生、灾害控制管理人员、伦理学家、灾害管理专家、患者安全专家，以及在疾病严重程度评分和决策工具方面有经验的院士)，以开发一个算法/标准集，以便对适合出院的患者进行风险分层；(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)前瞻性地测试并随后改进所得到的工具；(3)测试其 在执业医生手中的适用性，作出进一步的改进，以及(4)通过模拟演习，比较开发的工具识别被认为可以提前出院的安全患者的能力，与目前识别灾难后宣布的患者的特别方法。我们相信，最终的交付成果；一种可推广的、经过验证的方法，预先指定住院患者安全及早出院，将在全国医院具有广泛的适用性，以便在发生BT或其他关键事件时快速创建激增能力。

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.