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Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care.
Pediatrics. 2007 Jan; 119(1):94-100.Ped

Abstract

BACKGROUND

Federal planners have suggested that one strategy to accommodate disaster surges of 500 inpatients per million population would involve altering standards of care. No data are available indicating the extent of alterations necessary to meet disaster surge targets.

OBJECTIVE

Our goal was to, in a Monte Carlo simulation study, determine the probability that specified numbers of children could be accommodated for PICU and non-ICU hospital care in a disaster by a set of strategies involving altered standards of care.

METHODS

Simulated daily vacancies at each hospital in New York City were generated as the difference between peak capacity and daily occupancy (generated randomly from a normal distribution on the basis of empirical data for each hospital). Simulations were repeated 1000 times. Capacity for new patients was explored for normal standards of care, for expansion of capacity by a discretionary 20% increase in vacancies by altering admission and discharge criteria, and for more strictly reduced standards of care to double or quadruple admissions for each vacancy. Resources were considered to reliably serve specified numbers of patients if that number could be accommodated with a probability of 90%.

RESULTS

Providing normal standards of care, hospitals in New York City would reliably accommodate 250 children per million age-specific population. Hypothetical strict reductions in standards of care would reliably permit hospital care of 500 children per million, even if the disaster reduced hospital resources by 40%. On the basis of historical experience that as many as 30% of disaster casualties may be critically ill or injured, existing pediatric intensive care beds will typically be insufficient, even with modified standards of care.

CONCLUSIONS

Extending resources by hypothetical alterations of standards of care would usually satisfy targets for hospital surge capacity, but ICU capacity would remain inadequate for large disasters.

Authors+Show Affiliations

Department of Pediatrics, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA. kanterr@upstate.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17200275

Citation

Kanter, Robert K., and John R. Moran. "Pediatric Hospital and Intensive Care Unit Capacity in Regional Disasters: Expanding Capacity By Altering Standards of Care." Pediatrics, vol. 119, no. 1, 2007, pp. 94-100.
Kanter RK, Moran JR. Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care. Pediatrics. 2007;119(1):94-100.
Kanter, R. K., & Moran, J. R. (2007). Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care. Pediatrics, 119(1), 94-100.
Kanter RK, Moran JR. Pediatric Hospital and Intensive Care Unit Capacity in Regional Disasters: Expanding Capacity By Altering Standards of Care. Pediatrics. 2007;119(1):94-100. PubMed PMID: 17200275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care. AU - Kanter,Robert K, AU - Moran,John R, PY - 2007/1/4/pubmed PY - 2007/1/31/medline PY - 2007/1/4/entrez SP - 94 EP - 100 JF - Pediatrics JO - Pediatrics VL - 119 IS - 1 N2 - BACKGROUND: Federal planners have suggested that one strategy to accommodate disaster surges of 500 inpatients per million population would involve altering standards of care. No data are available indicating the extent of alterations necessary to meet disaster surge targets. OBJECTIVE: Our goal was to, in a Monte Carlo simulation study, determine the probability that specified numbers of children could be accommodated for PICU and non-ICU hospital care in a disaster by a set of strategies involving altered standards of care. METHODS: Simulated daily vacancies at each hospital in New York City were generated as the difference between peak capacity and daily occupancy (generated randomly from a normal distribution on the basis of empirical data for each hospital). Simulations were repeated 1000 times. Capacity for new patients was explored for normal standards of care, for expansion of capacity by a discretionary 20% increase in vacancies by altering admission and discharge criteria, and for more strictly reduced standards of care to double or quadruple admissions for each vacancy. Resources were considered to reliably serve specified numbers of patients if that number could be accommodated with a probability of 90%. RESULTS: Providing normal standards of care, hospitals in New York City would reliably accommodate 250 children per million age-specific population. Hypothetical strict reductions in standards of care would reliably permit hospital care of 500 children per million, even if the disaster reduced hospital resources by 40%. On the basis of historical experience that as many as 30% of disaster casualties may be critically ill or injured, existing pediatric intensive care beds will typically be insufficient, even with modified standards of care. CONCLUSIONS: Extending resources by hypothetical alterations of standards of care would usually satisfy targets for hospital surge capacity, but ICU capacity would remain inadequate for large disasters. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/17200275/Pediatric_hospital_and_intensive_care_unit_capacity_in_regional_disasters:_expanding_capacity_by_altering_standards_of_care_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=17200275 DB - PRIME DP - Unbound Medicine ER -