Surge Capacity Plan

EMERGENCY DEPARTMENT

Surge capacity strategies will be implemented when volume exceeds staffing and/or treatment space

POLICY:

To ensure the provision of safe and timely care of the emergency patient during volume and/or acuity surges

PURPOSE:

1. Triggers for initiation of strategies include TWO or More of the following: (a) 5 or more patients waiting to be triaged (b) All treatment spaces occupied (c) Door to doctor times exceed 45 minutes, 3 or more EMS

critical arrivals at the same time (d) Patients being boarded in the ED for more than 1 hour (e) Nurse to patient ratio exceed 5:1

SPECIAL INSTRUCTIONS:

2. Call a Team Huddle (Physician, Charge Nurse, House Supervisor, Admitting and Triage Nurses) and discuss and identify any bottlenecks.

(Remember that bottlenecks are a moving target and can change as strategies are implemented)

SPECIAL INSTRUCTIONS:

3. Implement strategies for bottlenecks identified

SPECIAL INSTRUCTIONS:

Consider setting up a second triage or putting a Mid Level Provider in triage to perform Medical Screening Examinations for non-acute patients.

INTAKE BOTTLENECK

Set up chairs in the hallway for vertical patients, or place them in a consultation room.

Call for extra stretchers and open up the shell space for surges exceeding the hall space.

If more space is needed in the waiting area for families, route them to the main lobby area.

SPACE BOTTLENECK

(example: over half of nurses are in the trauma rooms and nurses are needed to care for patients in the regular ED) 1. Call in the on-call nurse 2. Call the house supervisor for RN help to be pulled from the

floors 3. If you are unable to provide nurses to transport patients

upstairs, call the floor nurses to come to the ED to get the patients

4. In a house wide disaster, send a message out on Everbridge for all staff to check in

5. Collaborate with the medical staff for additional coverage available if needed. When surge protocol is initiated, the physician working must stay a minimum of 2 hours after their shift. There should be NO handoffs by the physician during a surge.

STAFF DEFICIT

1. Contact Bed Control to determine why there is a delay

2. Contact the House Supervisor to make them aware of the issue and to help open up beds as needed.

3. If getting dirty beds assigned, contact Housekeeping to get more bed makers.

4. If nurses are needed to transport patients and the ED nurses are not available, call the floor and request that they come down to get their patients

ADMISSION (BED) DELAYS

1. Designate a temporary discharge team to clear the department (dispense meds “to go” if appropriate)

2. Move patients going home out of treatment spaces to holding/consultation rooms for discharge teams

DISCHARGE BOTTLENECK

1. Determine if transporters are needed or if another radiology tech is needed

2. Assign ED orderly to transport to radiology3. Use portable equipment if possible4. If additional radiology tech is needed, contact and

discuss with the radiology charge person

RADIOLOGY BOTTLENECK

1. Request another phlebotomist if that is a problem2. If Stat ED is down, send the specimens to the main

lab3. If pneumatic tube is down, contact the lab for

runners

LABORATORY BOTTLENECK

Identify if the situation meets criteria denoted in AD 4-4 for ambulance diversion

AMBULANCE

ED Leadership Monthly, Volume 4, Number 7, July 2012

REFERENCE