Hospital bed surge capacity in the event of a mass-casualty incident.
BACKGROUND
Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualty incident.


OBJECTIVE
To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities.


METHODS
Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient.


RESULTS
A total of 1,741 assessments of 788 patients by 82 nurse managers and 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than were nurse managers to send patients to such a facility or discharge them, but less likely to transfer patients out of the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses.


CONCLUSIONS
A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.
Davis
Daniel P
DP
UCSD Emergency Medicine, 200 West Arbor Drive #8676 San Diego, CA 92103 USA. davismd@cox.net
Poste
Jennifer C
JC
Hicks
Toni
T
Polk
Deanna
D
Rymer
Thérèse E
TE
Jacoby
Irving
I
D001509:Bed Occupancy / Q000379:methods; D002140:California; D003430:Cross-Sectional Studies; D004189:Disaster Planning / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008399:Mass Behavior; D011446:Prospective Studies