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."

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