Creation of inpatient capacity during a major hospital relocation: lessons for disaster planning.
OBJECTIVE
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.


METHODS
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.


METHODS
Large metropolitan university teaching hospital.


METHODS
Hospital census figures and patient outcomes.


RESULTS
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.


CONCLUSIONS
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.
Jen
Howard C
HC
David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Shew
Stephen B
SB
Atkinson
James B
JB
Rosenthal
J Thomas
JT
Hiatt
Jonathan R
JR
D002140:California; D002959:Civil Defense; D004189:Disaster Planning; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D010360:Patient Transfer / Q000379:methods*; D011446:Prospective Studies; D055872:Surge Capacity