Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Emergency department (ED) overcrowding has become a frequent topic of investigation. Despite a significant body of research, there is no standard definition or measurement of ED crowding. Four quantitative scales for ED crowding have been proposed in the literature: the Real-time Emergency Analysis of Demand Indicators (READI), the Emergency Department Work Index (EDWIN), the National Emergency Department Overcrowding Study (NEDOCS) scale, and the Emergency Department Crowding Scale (EDCS). These four scales have yet to be independently evaluated and compared. ⋯ At the study site, the suggested thresholds of the published crowding scales did not agree with providers' perceptions of ED crowding. Even after adjusting the scales to site-specific thresholds, a relatively low prevalence of ED crowding resulted in unacceptably low positive predictive values for each scale. These results indicate that these crowding scales lack scalability and do not perform as designed in EDs where crowding is not the norm. However, two of the crowding scales, EDWIN and NEDOCS, and one of the READI subscales, bed ratio, yielded good predictive power (AROC >0.80) of perceived ED crowding, suggesting that they could be used effectively after a period of site-specific calibration at EDs where crowding is a frequent occurrence.
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In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. ⋯ S. military may serve to educate colleagues who may be required to respond or react to an event that taxes the current health care system. This report presents concrete examples of surge capacity strategies used by both Israel and the U. S. military and provides solutions that may be applied to other health care systems when faced with similar situations.
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This report reflects the proceedings of a breakout session, "Surge Capacity: Defining Concepts," at the 2006 Academic Emergency Medicine Consensus Conference, "Science of Surge Capacity." Although there are several general descriptions of surge capacity in the literature, there is no universally accepted standard definition specifying the various components. Thus, the objectives of this breakout session were to better delineate the components of surge capacity and to outline the key considerations when planning for surge capacity. Participants were from diverse backgrounds and included academic and community emergency physicians, economists, hospital administrators, and experts in mathematical modeling. ⋯ The focus on enhancing surge capacity during a catastrophic event will be to increase patient-care capacity, rather than on increasing things, such as beds and medical supplies. Although there are similarities between daily surge and disaster surge, during a disaster, the goal shifts from the day-to-day operational focus on optimizing outcomes for the individual patient to optimizing those for a population. Other key considerations in defining surge capacity include psychosocial behavioral issues, convergent volunteerism, the need for special expertise and supplies, development of a standard of care appropriate for a specific situation, and standardization of a universal metric for surge capacity.
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The dramatic escalation of bioterrorism and public health emergencies in the United States in recent years unfortunately has coincided with an equally dramatic decline in the institutions and services we rely on for emergency preparedness. Hospitals in nearly every metropolitan area in the country have closed; those that remain open have reduced the number of available beds. "Just in time" supplies and health professional shortages have further compromised the nation's overall surge capacity. ⋯ The Agency for Healthcare Research and Quality and other government and private agencies have been rapidly widening the field of knowledge in this area in recent months and years. This report focuses primarily on the work of the Agency for Healthcare Research and Quality.
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Metrics are the driver to positive change toward better patient care. However, the research into the metrics of the science of surge is incomplete, research funding is inadequate, and we lack a criterion standard metric for identifying and quantifying surge capacity. Therefore, a consensus working group was formed through a "viral invitation" process. ⋯ These statements emphasize the importance of funded research in the area of surge capacity metrics; the utility of an emergency medicine research registry; the need to make the data available to clinicians, administrators, public health officials, and internal and external systems; the importance of real-time data, data standards, and electronic transmission; seamless integration of data capture into the care process; the value of having data available from a single point of access through which data mining, forecasting, and modeling can be performed; and the basic necessity of a criterion standard metric for quantifying surge capacity. Further consensus work is needed to select a criterion standard metric for quantifying surge capacity. These consensus statements cover the future research needs, the infrastructure needs, and the data that are needed for a state-of-the-art approach to surge and surge capacity.