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.
David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Howard C
HC
Jen
Stephen B
SB
Shew
James B
JB
Atkinson
J Thomas
JT
Rosenthal
Jonathan R
JR
Hiatt
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