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Paediatric major incident simulation and the number of discharges achieved using a major incident rapid discharge
Ruth Bird1, Daniel Braunold2, Jack Dryburgh-Jones3
1Anaesthetics, Royal London Hospital, London, UK ruth.bird3@nhs.net.
Insights
Hospitals can improve patient flow during major incidents (MI) by implementing prompt discharge policies. A simulated MI demonstrated that a formalised discharge plan created 40% extra ward capacity and threefold increase in critical care beds.
Area of Science:
- Emergency Medicine
- Hospital Administration
- Patient Flow Management
Background:
- Hospitals must maintain major incident (MI) plans, focusing on casualty acceptance.
- Existing plans often overlook discharge planning for current inpatients, hindering surge capacity.
- Effective patient discharge is crucial for maintaining departmental flow and accommodating new admissions.
Purpose of the Study:
- To assess the number of beds made available by a paediatric major incident discharge policy.
- To evaluate the impact of prompt patient discharge on overall hospital patient flow.
- To test the hypothesis that efficient discharge improves departmental flow during surge events.
Main Methods:
- A simulated major incident was conducted at a London major trauma centre.
- Discharge plans were initiated for admitted paediatric patients using live bed boards.
- Hospital bed occupancy and discharge capacity were audited, with follow-up for discharged patients.
Main Results:
- Twenty-nine ward beds were created, representing 42% of total capacity.
- Handwritten discharge summaries were significantly faster than electronic ones.
- Level 3 critical care capacity was tripled, and an additional 40% ward capacity was generated.
Conclusions:
- A formalised discharge plan enhances the speed and efficiency of safe patient release during major incidents.
- Handwritten discharge letters using carbon copy improved tracking and saved time.
- Robust follow-up procedures are essential for patients discharged under emergency protocols.
Objectives:
Hospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions.
Method And Setting:
A simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days.
Results:
Twenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed.
Conclusion:
We increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged.
