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Principal Investigators: Gabor Kelen, MD

Research Question:

Medical surge capacity has been an important concern for contingency planners. Homeland Security Presidential Directive (HSPD)-21 directly raises this concern. Considerable work has been undertaken by PACER, AHRQ and others to define the expected size of medical surge for variously scoped hazards contained in the current National Planning Scenarios (NPS). However, there has been a paucity of work to determine the capacity of any portion of the health system to absorb a surge. Furthermore, the need for quantifying surge capacity has practical applications in many sectors beyond healthcare, including supply chain and other critical infrastructure areas. PACER investigators have previously defined medical surge capacity and have developed a mathematical framework for its calculation. The variables and their mathematical relationships have also been defined. Work on identifying subcomponents of these variables is ongoing. Once identified, it is important to build a model incorporating the variables to determine which ones have the greatest effect or cause the greatest variability in predictive outcomes. Once these are determined, a useful tool that allows user entered data to estimate surge capacity for various hazards can be developed. Further, such a tool allows end users to determine which variables can maximize surge capacity most efficiently.

The purpose of this study is to translate the most up to date science on surge capacity into a functional tool – in this case an applet that allows its user to estimate surge capacity for a given hazard in a given medical facility. Since the end-user has control over the input variables, the effect of certain operational tactics and strategies on augmentation or degradation of surge capacity can be ascertained. This control also provides the end product with adaptability that could inform various other sectors. This allows the facility to plan a stepwise phased implementation of surge response as dictated by the size of the surge.

This project will build on the work that was completed during project A-1 of PACER I. In project A-1, PACER researchers were able to form consensus on a comprehensive list of variables in four categories that may influence and alter surge capability within a health care system. This initial research was instrumental in the creation of a library of surge capacity variables from which to work, as well as foundations of an algorithm mathematical relationship between the variables and surge capacity. During PACER II, additional literature reviews, use of the conclusions of the the PACER I consensus conference) and a follow-up expert panel convention will allow PACER researchers to select the key variables form amongst hundreds identified, that are both readily measured and most contribute to the capacity prediction. The resulting key variables will ultimately inform the algorithm.

Analytic Approach:

The project will have two phases.

Phase 1, Description of surge model - In the first phase (year one), investigators will review literature regarding hospital surge and interview hospital personnel to identify and fully describe all variables that may have an impact on hospital surge. The interactions and potential correlativity of those variables will also be examined and described. This process will build upon existing literature and the information obtained will be organized, documented and used to develop the key aspects of the prototype surge model. Pertinent literature will be identified and reviewed by personnel looking for information on variables potentially important in the calculation of surge. A database of papers and other sources used to identify surge variables will be created, and the results of the review will be summarized.

When the literature is complete, the investigators will plan and convene an expert panel meeting to review the results of the review and determine which of those variables should be included in the prototype surge model. The panel will be comprised of individuals with expertise in hospital management, surge capacity, and medicine whose work makes them knowledgeable about the variables important in the calculation of surge to gain a better understanding of the effect of the different surge variables. This expert panel will be semi-quantitative. Investigators will begin with a series of standard questions, and probe deeply for additional information that may be related to surge. Questions from initial expert panel may be modified by information gained during initial interviews and a second panel may be addressed.

Phase 2, Creation and testing of ‘surge’ applet – Using information gained from the expert panel and literature, investigators will refine the parameters of the surge prototype model. The model will be comprised of specifically chosen high value variables from 3 components of the previously developed surge capacity model (Staff, Space, Supplies.) The key elements of the model will be informed by initial research on all possible relevant data comprising each of these three components, which as noted will be refined according to strategic value by an expert panel assessment.

A free standing computer applet, suitable for DVD distribution, will be developed that allows users to run the surge prototype model using pertinent institution specific which reveals baseline surge capacity at their institution. Initially the prototype applet will model surge capacity for an emerging infection/pandemic influenza-like situation for a given medical ward. The applet will likely be written in C# programming language in order to be compatible with the EMCAPS application. The applet will be developed with input from investigators and interviews with knowledgeable hospital personnel. The prototype applet will be sent to a small group of hospital planners for testing. Feedback from these planners will be used to refine the applet further. The refined applet will be sent to a group of hospital planners for evaluation. A standardized questionnaire will be developed and sent to these planners along with the applet. The information gained from the questionnaire will be used to inform future refinements of the applet.