Leone Ryan M, Iavicoli Laura G, Silvestri David M, Salway R James
Ryan M. Leone, MSc, is a Medical Student, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, and a Visiting Scholar, National Center for Disaster Medicine and Public Health, Uniformed Services University, Bethesda, MD. Laura G. Iavicoli, MD, MBA, is a Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, and Chief Medical Officer, NYC Health + Hospitals/Elmhurst; both in New York, NY. David M. Silvestri, MD, MBA, MHS, is Assistant Vice President of Emergency Management, NYC Health + Hospitals, New York, NY. R. James Salway, MD, MSc, is an Assistant Professor of Emergency Medicine, Weill Cornell School of Medicine, New York, NY.
Health Secur. 2025 Mar-Apr;23(2):110-115. doi: 10.1089/hs.2024.0096. Epub 2025 Feb 27.
When patient demand exceeds hospital capacity in certain scenarios, such as natural disasters, terrorist attacks, or staffing shortages, the rapid discharge of patients identified through reverse triage methodologies can create surge capacity. The evaluation of this concept has been documented in numerous resources and studies, but current tools tend to be extensive and siloed, which may make them difficult to use during emergencies. To prepare the largest municipal healthcare system in the United States for situations requiring rapid patient discharge, NYC Health + Hospitals/Central Office Emergency Management sought to develop a short, synthesized, and user-friendly plan. After consulting experts and reviewing existing peer-reviewed articles, gray literature, and internal facility documents, the team created a 7-page rapid action checklist that synthesizes important content. The Risk-based, Abbreviated, Patient Identification Discharge (RAPID) tool was successfully used during a resident labor action in May 2023, illustrating that its utility may extend beyond the system in which it was used. Future work should be done to validate and improve upon this tool.
