1. Surge Capacity Toolkit for Hospitals William Lang Administrative Consultant Bioterrorism Hospital Preparedness Program, NYC DOHMH Contact Information: Tel. 914-262-5675 Email: wlangconsult@yahoo.com

2. NYC DOHMH 2007 Core Deliverables – C.1 & C.2 Submit a site-specific plan for increasing bed capacity Hospitals will be asked to: 1) Incorporate surge capacity tools and templates provided by DOHMH BHPP. 2) Review and incorporate previously prepared protocols, lessons learned from after action reports, and results of hospital assessments into their plan. 3) Participate in a BHPP-sponsored workshop (also known as “Surge Clinics”). 4) Submit Plans to DOHMH.

3. Tool Development Objectives Flexible/adaptable to the needs of participating hospitals Include recommendations and best practices from “Surge Clinics” Consistent formatting Easily understood Easy to use

4. Hospital Surge Categories

5. Surge Beds – Related Activities

6. Surge Beds – Groups of Activities

7. Surge – Bed Yielding Activities

8. UCSD Discharge Study, 2005 To determine how many acute care beds could be made available in the event of a mass casualty incident. 4 Hospitals 1741 Assessments 788 Patients 82 Nurse Manager 25 Physicians Hospital Bed Surge Capacity in the Event of a Mass-Casualty Incident; Davis, Poste, Hicks, Polk, Rhymer, Jacoby; May-June 2005; Prehospital and Disaster Medicine.

9. UCSD Discharge Study, 2005 Findings 33% of the patients were assessed as dischargeable at 24 hours; 50% at 72 hours. Conclusion Rapid discharge will be an efficient early intervention to increase bed capacity, Hospital Bed Surge Capacity in the Event of a Mass-Casualty Incident; Davis, Poste, Hicks, Polk, Rhymer, Jacoby; May-June 2005; Prehospital and Disaster Medicine.

10. Toolkit Features & Benefits Provides activity definitions, descriptions, outcomes, team members, estimated time to implement, and bed yield potential. Lessens reliance on “off-the-cuff” solutions. Assures all appropriate actions are engaged. Encourages planning involvement of subject matter experts.

11. Toolkit Features & Benefits \ Cont… Helps to assure regulatory compliance with discharge practices. Tools can be used by subject matter experts and non-experts alike. Can be used in tight bedding situations - not just in emergencies. Decreases length of stay!

12. Tool Development – Timeline (2006)  Nov 06: GNYHA  Nov 16: DOHMH forms Surge Capacity Workgroup  Nov 30: DOHMH Materials distributed to Hospitals (Rapid Discharge Tool, Beds Planning Committee guidance document)  Nov-Dec: Hospitals form Beds Planning Committees

13. Tool Development – Timeline (2007)  Jan 17: DOHMH Materials distributed to Hospitals (Capacity Expansion tools)  Jan: Hospitals begin work on Draft Surge Plans.  Feb: Hospitals attend Surge Clinics (one-day), sponsored by DOHMH  Mar: Hospitals submit Draft Plans to DOHMH

14. Where to Begin? Begin to assess current discharge practices in your own institutions by asking: – Who are the key individuals involved in the discharge process? – Do you have unit-based discharge teams? – Do you have length-of-stay teams? – Do you have an “Intend to Discharge Form”? If so, how is it used? – Do you have policies and procedures governing patient discharge?

15. Summary & Conclusion FY 2006 Core Deliverables C.1 & C.2 - submit plans for increasing bed capacity. DOHMH provides rapid discharge and capacity expansion tools and templates. Hospitals review and submit to DOHMH materials comprising practices related to bed surge capacity. Hospitals participate in “Surge Clinics” to adapt best practices and recommendations to their own plans. Hospitals submit Draft & Final plans to the DOHMH.

16. William Lang Administrative Consultant Bioterrorism Hospital Preparedness Program, NYC DOHMH Contact Information: Tel. 914-262-5675 Email: wlangconsult@yahoo.com