Template:Harbor Surge plan

Surge Plan

There are three levels of surge. The surge level is determined by meeting a majority of the "Resource Utilization Indicators" (see below). When a surge level is met, the patient flow facilitator, in consultation with the ED attending, will enact the surge plan. Alerts go out to all hospital departments. If you think criteria have been met to activate the Surge Plan - contact the Patient Flow Facilitator at x3434 or on Beeper x0939.

What Happens in the ED* at Different Surge Levels

• Level 1
  • Ambulance Diversion (Diversion is for ALS only, never BLS)
  • Four RME Rooms should be converted to Fast Track if not already done
  • Assign residents as available to staff the extra Fast Track rooms
  • UR Nurse works with Hospitalist and Admitting Residents to identify 2.76 Transfers (Hospitalist and Nurse Analysts look for patients to transfer that County will find special funding for)
  • Charge nurse facilitates full staffing of Gold Unit by reallocating staff as available

• Level 2
  • Above and:
  • When beds are available upstairs, 4 OBS/CORE patients each hour are admitted and moved to inpatient beds. Hospitalist or CORE Cardiologist writes orders.

• Level 3
  • Above and:
  • CMO or designee makes determination to go on Diversion to Trauma
  • Medical Director considers Trauma diversion, stopping all non-emergent surgeries and clinic admits
  • When beds are available upstairs, 6 OBS/CORE patients each hour are admitted and moved to inpatient beds. Hospitalist or CORE Cardiologist writes orders.

There are multiple addional actions taken upstairs that are listed in the Surge Capacity Plan Policy (Hosp. Policy No. 337)

Resource Utilization Indicators (Need any 3, you no longer need a majority)

• Level 1
  • NEDOCS >140
  • > 50 Patients in Triage/Waiting Room
  • > 11 OBS/CORE/Boarders in AED
  • Inpatient census > 320
  • Low inpatient bed count (<16 Ward AND <5 ICU/PCU beds)

• Level 2
  • NEDOCS >180
  • > 50 Patients in Triage/Waiting Room
  • > 14 OBS/CORE/Boarders in AED
  • Inpatient census > 330
  • Lower inpatient bed count (<11 Ward AND <3 ICU/PCU beds AND No "Bump Bed" for Trauma or STEMI)
  • 4 or more patient in the Recovery Room (PAR) awaiting ICU/PCU/SDU

• Level 3
  • NEDOCS 200
  • > 75 Patients in Triage/Waiting Room
  • > 15 AAED Boarders (Do not count OBS or CORE patients)
  • Inpatient census > 345
  • Low inpatient bed count (<5 ward AND 0 ICU/PCU beds with no "Bumps")
  • 5 or more patient in the Recovery Room (PAR) awaiting ICU/PCU/SDU

(Hosp Policy 337)

Adult ED Attending Standard Work During Severe ED Overcrowding

• 1. Ensure that the MICN / Charge RN has updated the NEDOCS score.
• 2. If surge criteria met, call Patient Flow Facilitator to check if surge plan has been initiated.
• 3. If ED providers have extra capacity, see if the patients in waiting room can be evaluated/treated in RME and discharged. If MSE is behind and there are many patients are waiting for MSE, then assist with MSE and screen orders. Check with RME Charge RN and RME Provider for available nursing resources and open rooms.
• 4. Perform MSE on ambulance triage patients and write screening orders. Inform RME Charge RN that orders are pending.
• 5. If time allows, talk to Gold (CORE, ED hospitalist) providers to push for disposition decisions.
• 6. If time allows, go through patient charts on the admissions track and contact admitting inpatient teams of patients that might be downgradable.
• Suggestion: Consider using the RME Fast Track rooms to board the admitted patient in order to free up more acute rooms.

(Director AED, 2/22/2016)