Van Cleve William C, Hagan Pat, Lozano Paula, Mangione-Smith Rita
Department of Pediatrics, University of Washington and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, USA.
Jt Comm J Qual Patient Saf. 2011 Aug;37(8):376-82. doi: 10.1016/s1553-7250(11)37048-1.
On November 4, 2009, the 250-bed Seattle Children's Hospital (SCH) identified a surge in its census--245 inpatients, well above the average midnight census of 207. In response, SCH activated its pandemic influenza surge plan in an effort to decrease the inpatient census. Within 16 hours, 51 patients (20.4% of total bed capacity) had been discharged, and inpatient census at SCH decreased to 222 patients.
As part of a quality improvement project, SCH's response to the surge was investigated, with data drawn from interviews, a review of records created in the course of the surge plan implementation, an e-mail survey of attending physicians responsible for patient discharges, and models examining predictors of hospital discharges.
Analysis of three years of hospital data (2007-2009) indicated that the high census on November 4 was an uncommon but not unprecedented occurrence. In addition, there was a clear positive association between an evening's census and the number of discharges during the following 24 hours. SCH discharged essentially the same number of patients on November 4 as on previous high-census days when the surge plan was not activated, suggesting that the surge plan did not succeed in creating excess discharges.
Increasingly, evidence indicates that care quality depends on the degree to which hospital resources are sufficient to meet demand. Reverse triage, at least as implemented by SCH on November 4, 2009, is unlikely to represent an effective solution to surge outside of a disaster setting because of its requirement for centralized decision making. SCH has incorporated the results of this review into the way that it collects and analyzes data, manages flow, and responds to inpatient surges.
2009年11月4日，拥有250张床位的西雅图儿童医院（SCH）发现其住院人数激增——达到245名住院患者，远高于午夜平均住院人数207名。作为应对措施，SCH启动了大流行性流感应对预案，试图减少住院人数。在16小时内，51名患者（占总床位的20.4%）已出院，SCH的住院人数降至222名患者。
作为质量改进项目的一部分，对SCH对此次激增的应对措施进行了调查，数据来源于访谈、对激增预案实施过程中创建的记录的审查、对负责患者出院的主治医生的电子邮件调查以及检查医院出院预测因素的模型。
对三年医院数据（2007 - 2009年）的分析表明，11月4日的高住院人数是一次不常见但并非前所未有的情况。此外，当晚的住院人数与接下来24小时内的出院人数之间存在明显的正相关。SCH在11月4日出院的患者数量与之前未启动激增预案时的高住院人数日基本相同，这表明激增预案未能成功创造额外的出院人数。
越来越多的证据表明，医疗质量取决于医院资源满足需求的程度。反向分诊，至少就2009年11月4日SCH实施的情况而言，由于其需要集中决策，在非灾难情况下不太可能成为应对激增情况的有效解决方案。SCH已将此次审查的结果纳入其收集和分析数据、管理流程以及应对住院人数激增的方式中。
