Study of Med Center's Move Informs Surge Planning

The June 2008 relocation of the UCLA Medical Center involved limiting incoming transfers and more efficient discharge, enabling a smooth transition without interrupting emergency services, an Archives of Surgery paper reports.

Hospitals and other medical facilities are examining their ability to cope with surges of emergency patients as the U.S. flu season commences, and a new paper published in the September issue of Archives of Surgery, a JAMA journal, may help them. It describes the June 2008 relocation of the UCLA Medical Center to the Ronald Reagan UCLA Medical Center site, accomplished partly by limiting incoming transfers and more efficient discharge, the authors report.

"Thorough preparation requires a coordinated effort to determine the appropriate allocation of hospital resources to accommodate an acute influx of patients with needs for various services, including operative and other procedures," they write. "Surge capacity is rarely tested, as most disaster drills terminate after triage and immediate treatment in the emergency department and operating rooms." The paper's authors are lead author Dr. Jonathan R. Hiatt, chief of the division of general surgery; Dr. James Atkinson, senior medical director of hospital transition and professor of surgery; Dr. Tom Rosenthal, chief medical officer and associate vice chancellor for the UCLA Health System; Stephen Shew, assistant professor of surgery; and Howard Jen, senior resident in general surgery, all of whom are affiliated with the David Geffen School of Medicine and Ronald Reagan UCLA Medical Center.

The medical center had an average daily census of 525 patients before relocation planning began, and officials set a goal of 350 patients for moving day. "There were three components to our census management strategy," said Atkinson. "First, the elective surgery schedule was restricted beginning one week prior to move day, and operative volume was reduced by 45 percent. Second, incoming transfers were limited, leading to a reduction in both urgent and emergent admissions to medical and surgical services without limitation of trauma and emergency department admissions. Finally, a centralized multidisciplinary discharge team was used to enhance the efficiency of the discharge process."

These brought the census down by 36 percent, to 345 on moving day, with no change in the death rate among patients. Surgical services were reduced by 46 percent, non-surgical services by 30 percent, and elective operations decreased significantly. Hospital admissions decreased by 42 percent and discharges per occupied bed increased by 8 percent. "The majority of our strategies required three to four days to achieve significant census gains and would be particularly useful during disasters, such as hurricanes or illness epidemics, with longer lead times," Atkinson said in a news release about the study that was distributed by UCLA Health Sciences in Los Angeles. "When lead times are brief, such as earthquakes, urban bombings, or other mass-casualty incidents, strategies to bolster emergency department and trauma center preparedness are the first priority. In-patient capacity for continued hospital care of injured patients must also be generated simultaneously, and our model provides useful tools for this purpose."

The findings are particularly important given results of the analysis of regional capacity, which found that during a period in which the southern California population increased 8.5 percent, the number of acute care beds decreased by 3.3 percent. In addition, Los Angeles County emergency departments experienced a 13 percent diversion rate due to overcrowding. "Hospitals should create an internal plan using these principles of census management with modifications to reflect local characteristics," the authors conclude. "Finally, as many hospitals are currently operating at capacity, a regional and integrated systems approach to surge capacity creation is needed."

Download Center

  • Safety Metrics Guide

    Is your company leveraging its safety data and analytics to maintain a safe workplace? With so much data available, where do you start? This downloadable guide will give you insight on helpful key performance indicators (KPIs) you should track for your safety program.

  • Job Hazard Analysis Guide

    This guide includes details on how to conduct a thorough Job Hazard Analysis, and it's based directly on an OSHA publication for conducting JHAs. Learn how to identify potential hazards associated with each task of a job and set controls to mitigate hazard risks.

  • A Guide to Practicing “New Safety”

    Learn from safety professionals from around the world as they share their perspectives on various “new views” of safety, including Safety Differently, Safety-II, No Safety, Human and Organizational Performance (HOP), Resilience Engineering, and more in this helpful guide.

  • Lone Worker Safety Guide

    As organizations digitalize and remote operations become more commonplace, the number of lone workers is on the rise. These employees are at increased risk for unaddressed workplace accidents or emergencies. This guide was created to help employers better understand common lone worker risks and solutions for lone worker risk mitigation and incident prevention.

  • EHS Software Buyer's Guide

    Learn the keys to staying organized, staying sharp, and staying one step ahead on all things safety. This buyer’s guide is designed for you to use in your search for the safety management solution that best suits your company’s needs.

  • Vector Solutions

Featured Whitepaper

OH&S Digital Edition

  • OHS Magazine Digital Edition - July August 2022

    July / August 2022

    Featuring:

    • CONFINED SPACES
      Specific PPE is Needed for Entry and Exit
    • HAZARD COMMUNICATION
      Three Quick Steps to Better HazCom Training
    • GAS DETECTION
      Building a Chemical Emergency Toolkit
    • RESPIRATORY PROTECTION
      The Last Line of Defense
    View This Issue