Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events

Abstract

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.

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

“…This innovative solution is originally proposed for inpatients by Kelen et al (2009b), where a five-category scale is used to identify patients for early discharge. Although "triage at discharge" has been proposed as a crisis measure (Hick et al, 2009;Kelen et al, 2009a), Kelen et al (2009b) note that such a system could be used in daily ED operations. Powell et al (2012) illustrate the need to take a system wide approach in the hospital, particularly in discharge.…”

Implementing a negative-pressure isolation ward for a surge in airborne infectious patients

“…Because of these limitations, using existing hospital spaces and ventilation systems to establish a surge ward could be an improvement on previous negative-pressure isolation ward designs. Supplemental methods to increase surge capacity, such as reverse triage, 29 reducing nonurgent hospital admissions, 12 and delaying certain types of surgery, 30 could provide the room availability needed to establish a surge ward in a functioning hospital.…”

Emergency Department Design

“…Through such measures as delaying elective admissions and surgeries, early discharge, or interhospital transfer of stable patients, significant improvements in bed capacity can be accomplished within hours. 12,13 Although the capacity to handle patient surges is being addressed regionally and nationally, large events with high critical care volumes will overtax the system regionally, as was the case during Hurricane Katrina. The National Disaster Medical System (NDMS) can be mobilized to move excess victims and establish field hospitals during events involving hundreds or thousands of victims.…”