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Lessons for Disaster Planning

Howard C. Jen, MD; Stephen B. Shew, MD; James B. Atkinson, MD; J. Thomas Rosenthal, MD; Jonathan R. Hiatt, MD

Arch Surg. 2009;144(9):859-864.

Objective  To identify tools to aid the creation of disaster surge capacity using a model of planned inpatient census reduction prior to relocation of a university hospital.

Design  Prospective analysis of hospital operations for 1-week periods beginning 2 weeks (baseline) and 1 week (transition) prior to move day; analysis of regional hospital and emergency department capacity.

Setting  Large metropolitan university teaching hospital.

Main Outcome Measures  Hospital census figures and patient outcomes.

Results  Census was reduced by 36% from 537 at baseline to 345 on move day, a rate of 18 patients/d (P < .005). Census reduction was greater for surgical services than nonsurgical services (46% vs 30%; P = .02). Daily volume of elective operations also decreased significantly, while the number of emergency operations was unchanged. Hospital admissions were decreased by 42%, and the adjusted discharges per occupied bed were increased by 8% (both P < .05). Inpatient mortality was not affected. Regional capacity to absorb new patients was limited. During a period in which southern California population grew by 8.5%, acute care beds fell by 3.3%, while Los Angeles County emergency departments experienced a 13% diversion rate due to overcrowding.

Conclusions  Local or regional disasters of any size can overwhelm the system's ability to respond. Our strategy produced a surge capacity of 36% without interruption of emergency department and trauma services but required 3 to 4 days for implementation, making it applicable to disasters and mass casualty events with longer lead times. These principles may aid in disaster preparedness and planning.

Author Affiliations: Departments of Surgery and Urology (Dr Rosenthal); David Geffen School of Medicine at University of California, Los Angeles (Drs Jen, Shew, Atkinson, and Hiatt).

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