Emergency Department Surge Capacity Plan
Policy: • Surge capacity strategies will be implemented when volume exceeds staffing and/or treatment space
Purpose: • To ensure the provision of safe and timely care of the emergency patient during volume and/or acuity surges
Special Instructions: • 1. Triggers for initiation of strategies include TWOor 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
Intake Bottleneck • Consider setting up a second triage or putting a Mid Level Provider in triage to perform Medical Screening Examinations for non-acute patients.
Space 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.
Staff Deficit • (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.
Admission (bed) Delays • 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
Discharge Bottleneck • 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
Radiology Bottleneck • 1. Determine if transporters are needed or if another radiology tech is needed • 2. Assign ED orderly to transport to radiology • 3. Use portable equipment if possible • 4. If additional radiology tech is needed, contact and discuss with the radiology charge person
Laboratory Bottleneck • 1. Request another phlebotomist if that is a problem • 2. If Stat ED is down, send the specimens to the main lab • 3. If pneumatic tube is down, contact the lab for runners
Ambulance • Identify if the situation meets criteria denoted in AD 4-4 for ambulance diversion
Reference • ED Leadership Monthly, Volume 4, Number 7, July 2012