Jen Howard C, Shew Stephen B, Atkinson James B, Rosenthal J Thomas, Hiatt Jonathan R
David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Arch Surg. 2009 Sep;144(9):859-64. doi: 10.1001/archsurg.2009.146.
To identify tools to aid the creation of disaster surge capacity using a model of planned inpatient census reduction prior to relocation of a university hospital.
Prospective analysis of hospital operations for 1-week periods beginning 2 weeks (baseline) and 1 week (transition) prior to move day; analysis of regional hospital and emergency department capacity.
Large metropolitan university teaching hospital.
Hospital census figures and patient outcomes.
Census was reduced by 36% from 537 at baseline to 345 on move day, a rate of 18 patients/d (P < .005). Census reduction was greater for surgical services than nonsurgical services (46% vs 30%; P = .02). Daily volume of elective operations also decreased significantly, while the number of emergency operations was unchanged. Hospital admissions were decreased by 42%, and the adjusted discharges per occupied bed were increased by 8% (both P < .05). Inpatient mortality was not affected. Regional capacity to absorb new patients was limited. During a period in which southern California population grew by 8.5%, acute care beds fell by 3.3%, while Los Angeles County emergency departments experienced a 13% diversion rate due to overcrowding.
Local or regional disasters of any size can overwhelm the system's ability to respond. Our strategy produced a surge capacity of 36% without interruption of emergency department and trauma services but required 3 to 4 days for implementation, making it applicable to disasters and mass casualty events with longer lead times. These principles may aid in disaster preparedness and planning.
利用大学医院搬迁前计划性减少住院患者普查的模型，确定有助于建立灾难应对能力的工具。
对搬迁日开始前2周（基线）和1周（过渡期）的1周时间段内的医院运营进行前瞻性分析；分析区域医院和急诊科的能力。
大型都市大学教学医院。
医院普查数据和患者结局。
普查人数从基线时的537人减少了36%，搬迁日降至345人，减少速度为每天18名患者（P <.005）。手术科室的普查人数减少幅度大于非手术科室（46%对30%；P =.02）。择期手术的日手术量也显著下降，而急诊手术数量未变。医院入院人数减少了42%，每张占用床位的调整出院人数增加了8%（均P <.05）。住院患者死亡率未受影响。区域接收新患者的能力有限。在南加州人口增长8.5%的时期，急性护理床位减少了3.3%，而洛杉矶县急诊科因过度拥挤出现了13%的分流率。
任何规模的局部或区域灾难都可能超出系统的应对能力。我们的策略在不中断急诊科和创伤服务的情况下产生了36%的应对能力，但实施需要3至4天，适用于有较长预警时间的灾难和大规模伤亡事件。这些原则可能有助于灾难准备和规划。
