Table 1.

Sample priority actions to generate surge capacity at ‘City Hospital’

Conventional care locations:

1. Contact operating room and outpatient procedures to hold all procedures (if not already done)

2. Notify ICU charge nurses to begin transfers to appropriate floor care and develop list of additional patients that might be boarded on stepdown or floor units if required (see contingency care section)

3. Notify step-down and observation charge nurses to identify patients for transfer to floor care or discharge holding area

4. Fill available staffed beds per ‘bed board’

5. Open unstaffed units/beds

a. Notify operator to activate disaster inpatient nursing group page (if not already done)

b. Move available float and other staff to cover opening units until fully staffed

c. Notify staff staging of nursing needs on inpatient units

d. Notify facilities to remove beds from storage and place in designated rooms according to surge worksheet

6. If directed by incident manager, activate surge discharge plan

a. Request or activate Inpatient Disaster Pager (notifies all unit charge nurses, pharmacy, social work, bioelectronics, respiratory care, nurse manager group, medicine and critical care department chairs and chief residents) and activate surge discharge plan

b. Notify staff staging of nursing needs in discharge holding areas (Auditorium A and Classroom 121)

c. Notify patient transportation department of need for wheelchair internal and external transports

Contingency care: provide preoperative and postoperative holding and pre-admit temporary holding areas, transfer current inpatients to lower acuity care area

1. Units listed on worksheet are in overflow priority for ICU. Created beds in ICUs do not have dedicated monitors—notify bioelectronics of number needed (may be drawn from ED, outpatient, crash carts)

2. Request additional staffing as needed for post-anesthesia care (6 beds), pre-induction (6 beds) and special procedures/outpatient surgery unit (12 beds up to 24 beds)

3. Move stable ICU patients to step-down units, move step-down and rule-outs to non-monitored beds as appropriate

4. Transfer patients from monitored to non-monitored beds as appropriate

5. Staff gastroenterology laboratory and cardiac outpatient area if required

6. Move cots to pre-designated discharge holding area/waiting areas for holding patients pending transfers and clearing rooms

7. Assess with Planning Chief need to activate regional transfer plan and for additional/follow-on staff and material resources

Crisis care

1. Add cots or stretchers, transfer stable critical care patients with less resource demand to medicine floors (medical units are preferred by location to surgery, neurology, pediatric floor beds due to location) according to demand based on surge capacity worksheet

2. Note additional beds created in units and halls do not have dedicated monitoring systems. Call bioelectronics for any additional spares and ask that they pull Accident & Emergency (A&E) orthopedic area monitors, crash cart monitors, and depending on needs may move portable monitors from surgery/procedure areas. May need to make request to other facilities or discontinue cardiac/invasive monitoring to decrease demand. Can also use saturation monitor for high/low rate alarm—respiratory care can assist re-allocation of saturation monitors

3. Assess situation with Planning Section Chief—as above—if internal/external transfers will not allow patients to move off cots within 6 h then:

Decompression/demobilization

In conjunction with incident manager prepare patient lists for transfer—focus on those that are stable or with resource needs that are difficult to meet in the current environment but do not preclude transfer. As more resources and staff become available and transfers are made to other institutions, transition critical care back to contingency and then conventional locations, restoring normal operations and care locations

Note that these represent a small portion of an overall surge capacity plan (which itself is a portion of the institutional emergency operations plan) and should be tailored to the needs of the facility