YNHH launches new plan for handling surges in patient volume

Managing the hospital’s patient volume from day to day requires an enormous amount of communication and coordination among many different departments. So what happens when there’s a surge in volume, say, during the height of flu season?

Recently a clinical redesign team consisting of physicians, clinicians and non-clinical staff came together to find out, and to develop a hospital-wide plan to ensure all departments are prepared for surges. The team included representatives from the Emergency Department (ED), inpatient areas, Patient Transport, Environmental Services, nursing, Radiology and other departments.

First, the team needed to define what “surge” means.

“When we started assessing our ability to implement operational strategies and processes that would enable us to support a surge event, we discovered that many departments had their own surge plans,” said team member Melissa Davis, MD. “There was no one way to determine what surge was, as we did not have a singular, clear definition that was common to all areas.”

The clinical redesign team defined surge as “when the number of patients presenting to the Emergency Department, inpatient setting or any care area results in significant stress to hospital resources, requiring strategizing, coordination, collaboration and communication among all areas of the organization.”

The team’s next step was to create a proactive, rather than reactive, systemic approach to providing patient care during surges. They used information gathered through the hospital’s Capacity Command Center, which launched last fall. The center is staffed 24/7 by representatives from a variety of departments who view dashboards showing real-time data on bed capacity, patient transport status, ED operations, nurse staffing and other critical information.

The data collected through these dashboards can help create predictive models which combine historical and current data to predict future scenarios – for example, when the hospital might reach or exceed capacity. Using this information, the clinical redesign team developed and launched a comprehensive, detailed surge plan that identifies three states: pre-surge, surge and discharge surge.

“Pre-surge is the most important level,” Dr. Davis explained. “This level can prevent us from going into surge by asking what routine things we can do on a regular basis that are easy to implement and increase our capacity.”

If the hospital does experience a surge event, additional beds will be opened to accommodate at least 83 adult and seven pediatric patients. The surge plan covers other actions departments throughout the hospital will take to ensure all patients receive timely, optimal care in the appropriate setting.

“What we’ve done in a robust, data-oriented way is implement a proactive strategy to ensure patient flow and access from admission through discharge,” Dr. Davis said. “This was a massive effort of the departments across the hospital.”

For more information or to offer feedback about the surge plan, contact Dr. Davis at melissa.a.davis@yale.edu.