1. Surge Capacity Plan EMERGENCY DEPARTMENT

2.  Surge capacity strategies will be implemented when volume exceeds staffing and/or treatment space POLICY:

3.  To ensure the provision of safe and timely care of the emergency patient during volume and/or acuity surges PURPOSE:

4.  1. Triggers for initiation of strategies include TWO or More of the following:  (a) 5 or more patients waiting to be triaged  (b) All treatment spaces occupied  (c) Door to doctor times exceed 45 minutes, 3 or more EMS critical arrivals at the same time  (d) Patients being boarded in the ED for more than 1 hour  (e) Nurse to patient ratio exceed 5:1 SPECIAL INSTRUCTIONS:

5.  2. Call a Team Huddle (Physician, Charge Nurse, House Supervisor, Admitting and Triage Nurses) and discuss and identify any bottlenecks. (Remember that bottlenecks are a moving target and can change as strategies are implemented) SPECIAL INSTRUCTIONS:

6.  3. Implement strategies for bottlenecks identified SPECIAL INSTRUCTIONS:

7.  Consider setting up a second triage or putting a Mid Level Provider in triage to perform Medical Screening Examinations for non-acute patients. INTAKE BOTTLENECK

8.  Set up chairs in the hallway for vertical patients, or place them in a consultation room.  Call for extra stretchers and open up the shell space for surges exceeding the hall space.  If more space is needed in the waiting area for families, route them to the main lobby area. SPACE BOTTLENECK

9.  (example: over half of nurses are in the trauma rooms and nurses are needed to care for patients in the regular ED)  1. Call in the on-call nurse  2. Call the house supervisor for RN help to be pulled from the floors  3. If you are unable to provide nurses to transport patients upstairs, call the floor nurses to come to the ED to get the patients  4. In a house wide disaster, send a message out on Everbridge for all staff to check in  5. Collaborate with the medical staff for additional coverage available if needed. When surge protocol is initiated, the physician working must stay a minimum of 2 hours after their shift. There should be NO handoffs by the physician during a surge. STAFF DEFICIT

10.  1. Contact Bed Control to determine why there is a delay  2. Contact the House Supervisor to make them aware of the issue and to help open up beds as needed.  3. If getting dirty beds assigned, contact Housekeeping to get more bed makers.  4. If nurses are needed to transport patients and the ED nurses are not available, call the floor and request that they come down to get their patients ADMISSION (BED) DELAYS

11.  1. Designate a temporary discharge team to clear the department (dispense meds “to go” if appropriate)  2. Move patients going home out of treatment spaces to holding/consultation rooms for discharge teams DISCHARGE BOTTLENECK

12.  1. Determine if transporters are needed or if another radiology tech is needed  2. Assign ED orderly to transport to radiology  3. Use portable equipment if possible  4. If additional radiology tech is needed, contact and discuss with the radiology charge person RADIOLOGY BOTTLENECK

13.  1. Request another phlebotomist if that is a problem  2. If Stat ED is down, send the specimens to the main lab  3. If pneumatic tube is down, contact the lab for runners LABORATORY BOTTLENECK

14.  Identify if the situation meets criteria denoted in AD 4-4 for ambulance diversion AMBULANCE

15.  ED Leadership Monthly, Volume 4, Number 7, July 2012 REFERENCE