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April 7, 2020

During national or local “disasters” hospitals may face overwhelming inpatient volumes for which usual emergency management plan activities may be stressed. The following are considerations for guidelines of various activities necessary to expand capacity in order to effectively cope with incident-related surge inpatient volume. In many cases these considerations may simply supplement the organization’s emergency management plan activities or they may encourage alternative measures for expanding capacity.

Guidelines:

Surge capacity actions are intended to be specific to the nature of the incident causing the inpatient surge. Triggers for decision-making related to the type of incident should be developed which will drive types of responses (infectious, hazardous materials, mass trauma, etc.).

  1. Assessment of the incident including type and potential impact
  2. Establish Incident Command Center
  3. Triage of Patients
  4. Increase Bed Capacity (consider all locations where patients may be housed)
    • Cohort patients as possible pursuant to condition
    • Cancel elective procedures/surgeries
      • Transition Empty Outpatient/Day Surgery Area to inpatient beds
    • Open closed units
    • Consider on-site clinics for capacity (physical environment conditions will need to be evaluated)
    • Open procedural holding areas such as catherization holding areas
      • Consider using imaging rooms for ED overflow, transitional care or holding
      • Consider procedure rooms with negative pressure capacity as isolation rooms (procedures must be cancelled)
    • Cordon off appropriate component of PACU to use as Critical Care overflow
    • Ensure full use of all double rooms or 4-6 bed wards. In 4-6 bed wards, consider adding beds if sufficient space between beds is present and allows:
      • Privacy
      • Sufficient room to conduct care (e.g., equipment, perform treatments)
      • Prevention of contaminant transmission
  5. Determination of Saturation Level
  6. Alternative Staffing Plans
    • Follow service specific surge staffing plans
  7. Supply Chain
  • Immediate inventory of unit PAR levels
    • Unit supplies should be stocked to maintain full operations for a 72-hour period for each unit
    • Immediate inventory of Supply Chain stock
    • Implement vendor emergency supply (specific pre-determined orders which can be filled and shipped/retrieved within a 24-48-hour period) orders as needed
    • Collaborate with system supply chain and coordinate supply stock for distribution throughout chain as needed
      • Identify physical area in hospital for stockpile of supplies

8. Departments

Respiratory Therapy

  • Inventory supplies (including oxygen tanks), consider projected need and obtain from vendor
  • Inventory current ventilator use, and project surge ventilator use and obtain from vendor
  • Prioritize patients requiring respiratory services, consider if any treatments can be performed by nursing staff, or if treatments can be postponed or eliminated

Pharmacy

  • Inventory medication supply, identify surge needs
    • Consider medications needed for to manage specific incident
      • Include clinics, other alternative sites
      • Plan for acceleration of emergency medication (crash cart) needs
    • Contact supplier/wholesaler to meet real/projected need
    • If part of a system, collaborate with system pharmacy oversight to coordinate provision of medications/pharmaceutical supplies to site
    • Coordinate with other hospitals in the area for medication need
    • Consider PPE preservation (if needed) when compounding/preparing medications
  • Determine delivery schedule/method based on nature of incident
    • Retrieval
    • Emergency delivery
  • Determine delivery schedule/method based on nature of incident
    • Retrieval from off-site locations
    • Emergency delivery
    • Expedited routine delivery

Food and Nutritional Services

  • Inventory existing food/water supply and emergency food supply (72-96 hours on hand)
    • Include high traffic areas (entrances/waiting areas/ED)
    • Include projected staff/visitor need for prolonged surge
  • Consider nutritional stations throughout hospital and stock as appropriate and able
  • Consider accelerated delivery schedule from vendors
  • Coordinate with other hospitals in the area for food/water need

Laboratory

  • Inventory supplies, reagents, kits, etc. to maintain fully operational
  • Inventory blood products
  • Contact vendors for supplies and blood products and notify of projected or actual need

Environmental Services

  • Inventory paper goods, cleaning/sanitizing chemicals, linen, other
    • Contact vendors for supplies and notify of projected or actual need
  • If linen vendor is unable to meet need, wash and sanitize in facility
  • Conservation of linen as possible
  • Consider accelerated delivery schedule from vendors
  • Coordinate with other hospitals in the area for paper goods, chemicals, linen

As hospitals address the challenges high influx of inpatient volumes, considerations such as those listed above can be implemented. The considerations listed will need to be individualized to organization specific needs and likely expanded upon based on the incident generating the influx. We hope this listing serves to assist hospitals as they manage current and future surge capacity situations.

Greeley’s core mission is to help hospitals deliver high-quality, cost-effective patient care. For more information on how Greeley can partner with your organization during this challenging time, please email info@greeley.com or call 888.749.3054. 

 

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