Discharge Criteria for Creation of Hospital Surge Capac*

Kelen, Gabor

Abstract

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.