Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Prehosp Disaster Med. 2011 Jun;26(3):224-9. doi: 10.1017/S1049023X11006248.
The ability to generate hospital beds in response to a mass-casualty incident is an essential component of public health preparedness. Although many acute care hospitals' emergency response plans include some provision for delaying or cancelling elective procedures in the event of an inpatient surge, no standardized method for implementing and quantifying the impact of this strategy exists in the literature. The aim of this study was to develop a methodology to prospectively emergency plan for implementing a strategy of delaying procedures and quantifying the potential impact of this strategy on creating hospital bed capacity.
This is a pilot study. A categorization methodology was devised and applied retrospectively to all scheduled procedures during four one-week periods chosen by convenience. The categorization scheme grouped procedures into four categories: (A) procedures with no impact on inpatient capacity; (B) procedures that could be delayed indefinitely; (C) procedures that could be delayed by one week; and (D) procedures that could not be delayed. The categorization scheme was applied by two research assistants and an emergency medicine resident. All three raters categorized the first 100 cases to allow for calculation of inter-rater reliability. Maximal hospital bed capacity was defined as the 95th percentile weekday occupancy, as this is more representative of functional bed capacity than is the number of licensed beds. The main outcome was the number of hospital beds that could be created by postponing procedures in categories B and C.
Maximal hospital bed capacity was 816 beds. Mean occupancy during weekdays was 759 versus 694 on weekends. By postponing Group B and C procedures, a mean of 60 beds (51 general medical/surgical and nine intensive care unit (ICU)) could be created on weekdays, and four beds (three general medical/surgical and one ICU) on weekends. This represents 7.3% and 0.49% of maximal hospital bed capacity and ICU capacity, respectively. In the event that sustained surge is needed, delaying all category B and C procedures for one week would lead to the generation of 1,235 hospital-bed days. Inter-rater reliability was high (kappa = 0.74) indicating good agreement between all three raters.
For the institution studied, the strategy of delaying scheduled procedures could generate inpatient capacity with maximal impact during weekdays and little impact on weekends. Future research is needed to validate the categorization scheme and increase the ability to predict inpatient surge capacity across various hospital types and sizes.
能够根据大规模伤亡事件生成医院床位是公共卫生准备的一个重要组成部分。尽管许多急症医院的应急计划包括在住院人数激增的情况下延迟或取消择期手术的一些规定，但文献中尚未存在实施和量化该策略的标准化方法。本研究旨在开发一种方法，以便前瞻性地制定延迟手术的应急计划，并量化该策略对创造医院床位容量的潜在影响。
这是一项试点研究。设计了一种分类方法，并回顾性地应用于通过方便选择的四个为期一周的时间段内的所有计划手术。分类方案将手术分为四类：（A）对住院容量没有影响的手术；（B）可以无限期延迟的手术；（C）可以延迟一周的手术；和（D）不能延迟的手术。两名研究助理和一名急诊医学住院医师应用了分类方案。所有三名评分者对前 100 例进行了分类，以计算组内可靠性。最大医院床位容量定义为第 95 个百分位工作日入住率，因为这比许可床位数更能代表实际床位容量。主要结果是通过推迟 B 类和 C 类手术可以创建的医院床位数量。
最大医院床位容量为 816 张。工作日平均入住率为 759 张，周末为 694 张。通过推迟 B 类和 C 类手术，平均可以在工作日创建 60 张床位（51 张普通医疗/外科和 9 张重症监护病房（ICU）），周末可以创建 4 张床位（3 张普通医疗/外科和 1 张 ICU）。这分别代表最大医院床位容量和 ICU 容量的 7.3%和 0.49%。如果需要持续的高峰需求，将所有 B 类和 C 类手术推迟一周将产生 1235 张医院床位日。评分者之间的组内可靠性很高（kappa = 0.74），表明所有三名评分者之间的一致性很好。
对于所研究的机构，推迟计划手术的策略可以在工作日最大程度地产生住院容量，而对周末的影响很小。需要进一步的研究来验证分类方案，并提高预测各种医院类型和规模住院人数激增能力。
