Facilitating emergency hospital evacuation through uniform discharge criteria.
BACKGROUND
Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria.


METHODS
Standards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013-2014, before and after formulation of discharge criteria.


RESULTS
Consensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p<0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST=8,452 versus MST=264,366, respectively; p<0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p=0.001).


CONCLUSIONS
The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans.
Ministry of Health, Jerusalem, Israel; Department of Emergency Medicine, Leon & Mathilde Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Keret
K
Sandra
Department of Emergency Medicine, Leon & Mathilde Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Hadassah Medical Center, Jerusalem, Israel.
Nahari
N
Meital
Shaare Zedek Medical Center, Jerusalem, Israel.
Merin
M
Ofer
Department of Emergency Medicine, Leon & Mathilde Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Prepared Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Aharonson-Daniel
AD
Limor
Shaare Zedek Medical Center, Jerusalem, Israel.
Goldberg
G
Sara
Disaster Management & Injury Prevention Dept., School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. Electronic address: adini@netvision.net.il.
Adini
A
Bruria
D003299:Cooperative Behavior; D016638:Critical Illness; D003697:Delphi Technique; D004189:Disaster Planning / Q000458:organization & administration* / Q000592:standards; D017598:Efficiency, Organizational / Q000592:standards*; D004630:Emergencies; D006761:Hospitals; D006801:Humans; D007557:Israel; D010360:Patient Transfer / Q000458:organization & administration* / Q000592:standards*; D015397:Program Evaluation; D018635:Rescue Work