Emergency Department Surge: Models and Practical Implications

Nager, Alan L.; Khanna, Kajal

doi:10.1097/ta.0b013e3181ad2aaa

Cited by 22 publications

(14 citation statements)

References 6 publications

(7 reference statements)

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“…Their four‐component approach (staff, stuff, structure, and systems) has since proved influential, though there has been a tendency for the fourth component, systems, to be neglected in favor of concentrating on “staff, stuff, and structures” (Barbisch ; Barbisch and Koenig ; Felland et al ; Hick et al , 2008b; Hota et al ; Hotchkin and Rubinson ; Nager and Khanna ; Schultz and Koenig ; Welzel et al ). Some authors have appended “space” (which overlaps with the other definitions of “structures”) to this trio of components.…”

Section: Resultsmentioning

confidence: 99%

“…Balcan et al ; Barthel et al ; Bradt et al ; Christian et al ; Custer et al ; Daugherty and Rubinson ; Fernandez et al ; Griffiths, Estipona, and Waterson ; Joshi and Rys ; Joynt et al ; Kaiser et al ; Kallman and Feury ; Kanter and Moran ; Lee et al ; Lynch, Koller, and Cocciardi ; Markovitz ; Mazowita ; Meltzer, McNeill, and Miller ; Mercer, Levis, and Reyes ; Nager and Khanna ; Nap et al , ; NCBI , ; Rubinson et al ; Sprung et al ; Tandberg and Qualls ; Van Cleve et al .…”

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confidence: 99%

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Health Systems’ “Surge Capacity”: State of the Art and Priorities for Future Research

2013

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Context: Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice. Methods:A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health. Findings:The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings. Conclusions:The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, 78Health Systems ' "Surge Capacity" 79 and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable highconsequence surges in demand.Keywords: surge capacity, disease outbreaks, disaster planning/organization and administration, disaster medicine/manpower. E vidence shows that the frequency of recorded casualty-producing natural hazard events has increased more than fourfold across the world since the mid-1970s (ADRC 2009;Guha-Sapir et al. 2011). Whether this is a result of more frequent events or of heighted exposure and vulnerability to hazards is unclear, as the detection of patterns and trends in the frequency of physical hazards requires millions (or hundreds of millions) of years. What is clear, however, is that demographic, social, and environmental shifts are forcing increasing numbers of people to occupy (hitherto avoided) areas (Dobbs et al. 2011; UN 2005). Vulnerabilities to natural hazard-induced disasters may be amplified in the future as processes of environmental degradation, ...

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Health Systems’ “Surge Capacity”: State of the Art and Priorities for Future Research

2013

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“…Those planning group intervention trials should consider demand forecasting procedures, as are used in clinical settings characterised by surges and slumps [74][75][76]. Anecdotal testimony from site staff and trial managers suggests that maintaining contact with participants during recruitment and follow-up stages helps to reduce attrition from research and intervention protocols [49].…”

Section: Recommendationsmentioning

confidence: 99%

Challenges in the design, planning and implementation of trials evaluating group interventions

Biggs

Hind

Gossage-Worrall

et al. 2020

Trials

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Background: Group interventions are interventions delivered to groups of people rather than to individuals and are used in healthcare for mental health recovery, behaviour change, peer support, self-management and/or health education. Evaluating group interventions in randomised controlled trials (RCTs) presents trialists with a set of practical problems, which are not present in RCTs of one-to-one interventions and which may not be immediately obvious. Methods: Case-based approach summarising Sheffield trials unit's experience in the design and implementation of five group interventions. We reviewed participant recruitment and attrition, facilitator training and attrition, attendance at the group sessions, group size and fidelity aspects across five RCTs. Results: Median recruitment across the five trials was 3.2 (range 1.7-21.0) participants per site per month. Group intervention trials involve a delay in starting the intervention for some participants, until sufficient numbers are available to start a group. There was no evidence that the timing of consent, relative to randomisation, affected post-randomisation attrition which was a matter of concern for all trial teams. Group facilitator attrition was common in studies where facilitators were employed by the health system rather than the by the grant holder and led to the early closure of one trial; research sites responded by training 'back-up' and new facilitators. Trials specified that participants had to attend a median of 62.5% (range 16.7%-80%) of sessions, in order to receive a 'therapeutic dose'; a median of 76.7% (range 42.9%-97.8%) received a therapeutic dose. Across the five trials, 75.3% of all sessions went ahead without the pre-specified ideal group size. A variety of methods were used to assess the fidelity of group interventions at a group and individual level across the five trials. Conclusion: This is the first paper to provide an empirical basis for planning group intervention trials. Investigators should expect delays/difficulties in recruiting groups of the optimal size, plan for both facilitator and participant attrition, and consider how group attendance and group size affects treatment fidelity.

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“…However, prospective refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety. (ED) crowding undermines the clinical quality, safety, and timeliness of care of both adults and children, [1][2][3][4] particularly when demand for ED care is high, such as during an influenza epidemic. Both the Institute of Medicine and Emergency Medical Services for Children program have highlighted the importance of researching best practices to reduce ED crowding.…”

Section: Conclusion and Relevancementioning

confidence: 99%

Feasibility of Web-Based Self-Triage by Parents of Children With Influenza-Like Illness

Price¹,

Fagbuyi²,

Harris³

et al. 2013

JAMA Pediatr

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Importance: Self-triage using web-based decision support could be a useful way to encourage appropriate careseeking behavior and reduce health system surge in epidemics. However, the feasibility and safety of this strategy have not previously been evaluated.Objective: To assess the usability and safety of Strategy for Off-site Rapid Triage (SORT) for Kids, a webbased decision support tool designed to translate clinical guidance developed by the Centers for Disease Control and Prevention to help parents and adult caregivers determine if a child with influenza-like illness requires immediate care in an emergency department (ED).Design: Prospective pilot validation study conducted between February 8 and April 30, 2012. Staff who abstracted medical records and made follow-up calls were blinded to the SORT algorithm's assessment of the child's level of risk.Setting: Two pediatric emergency departments in the National Capital Region.Participants: Convenience sample of 294 parents and adult caregivers who were at least 18 years of age; able to read and speak English; and the parent or legal guardian of a child 18 years or younger presenting to 1 of 2 EDs with signs and symptoms meeting Centers for Disease Control and Prevention criteria for influenza-like illness.Intervention: Completion of the SORT for Kids survey.Main Outcome Measures: Caregiver ratings of the website's usability and the sensitivity of the underlying algorithm for identifying children who required immediate ED management of influenza-like illness, defined as receipt of 1 or more of 5 essential clinical services.Results: Ninety percent of participants reported that the website was "very easy" to understand and use. Ratings did not differ by respondent race, ethnicity, or educational attainment. Of the 15 patients whose initial ED visit met explicit criteria for clinical necessity, the Centers for Disease Control and Prevention algorithm classified 14 as high risk, resulting in an overall sensitivity of 93.3% (exact 95% CI, 68.1%-99.8%). Specificity of the algorithm was poor. Conclusions and Relevance:This pilot study suggests that web-based decision support to help parents and adult caregivers self-triage children with influenza-like illness is feasible. However, prospective refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety.

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Emergency Department Surge: Models and Practical Implications

Abstract: There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.

Cited by 22 publications

References 6 publications

Health Systems’ “Surge Capacity”: State of the Art and Priorities for Future Research

Health Systems’ “Surge Capacity”: State of the Art and Priorities for Future Research

Challenges in the design, planning and implementation of trials evaluating group interventions

Feasibility of Web-Based Self-Triage by Parents of Children With Influenza-Like Illness

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