Reverse Triage to Increase the Hospital Surge Capacity in Disaster Response
Introduction: Successful and effective management of large-scale disasters and epidemics requires pre-established systematic plans to minimize the damage and control the situation. With an increasing number of people in need of urgent medical care, hospitals must improve their response capacity, being at the forefront of responding to disasters and incidents. One way to develop the hospital capacity in disaster response is by reverse triage (RT). Objective: The current study was conducted to investigate the role of RT to create additional hospital surge capacity in one of the major referral academic hospitals of Isfahan, Iran. Method: This cross-sectional study was conducted in 2015 at Al-Zahra Subspecialty Hospital, Isfahan, Iran. The ten most common diseases leading to hospitalization in each ward of the hospital in 2014 were reviewed and, based on the prevalence, sorted and listed. Academic instructions for making a decision and possibility of early discharge was written and approved by an expert panel. On a day that was not set previously, the pre-selected in-charge person of each department was asked to run the RT following the instructions, and the number and percentage of those who were eligible for discharge via RT were determined. Results: The total BOR in Al-Zahra Hospital in 2014 was about 80%, so it was estimated that almost 140 out of 700 beds are vacant. The results showed that by using RT, 108 (20%) hospitalized cases could be discharged, and considering the bed occupancy rate of about 80% and 140 vacant beds, a total of 248 beds could be provided following RT. Conclusion: Running RT in 41 wards and units of Isfahan Al-Zahra Hospital, on average, added 108 beds to the hospital capacity. This increment is not the same in all wards, as the role of intensive care units in RT for surge capacity is insignificant.
2. The International Disater Database [Internet]. 2016. Available from: http://www.emdat.be/database.
3. Guha-Sapir D, Vos F, Below R, Ponserre S. Annual disaster statistical review 2011: the numbers and trends. Centre for Research on the Epidemiology of Disasters (CRED), 2012.
4. Shi P, Wang Ja, Xu W, Ye T, Yang S, Liu L, et al. World Atlas of Natural Disaster Risk. In: Shi P, Kasperson R, editors. World Atlas of Natural Disaster Risk. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015. p. 309-23.
5. Ardalan A, Masoomi G, Goya M, Ghaffari M, Miadfar J, Sarvar M, et al. Disaster health management: Iran’s progress and challenges. Iranian J Publ Health. 2009;38(1):93-7.
6. Fearon JD. Civil War & the Current International System. Dædalus. 2017;146(4):18-32.
7. Al-Imam A, Santacroce R, Roman-Urrestarazu A, Chilcott R, Bersani G, Martinotti G, et al. Captagon: use and trade in the Middle East. Hum Psychopharmacol. 2016;32(3):e2548.
8. Koenig K, Schultz C. Disaster medicine: comprehensive principles and practices. Cambridge University Press; 2010.
9. Kelen GD, Kraus CK, McCarthy ML, Bass E, Hsu EB, Li G, et al. Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368(9551):1984-90.
10. Kelen GD, McCarthy ML, Kraus CK, Ding R, Hsu EB, Li G, et al. Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events. Disaster Med Public Health Prep. 2009;3(S1):S10-S6.
11. Pollaris G, Sabbe M. Reverse triage: more than just another method. Eur J Emerg Med. 2016;23(4):240-7.
12. Watson SK, Rudge JW, Coker R. Health systems’“surge capacity”: state of the art and priorities for future research. Milbank Q. 2013;91(1):78-122.
13. Ciottone GR, Biddinger PD, Darling RG, Fares S, Keim ME, Molloy MS. Ciottone's Disaster Medicine: Elsevier Health Sciences; 2015.
14. Einav S, Hick JL, Hanfling D, Erstad BL, Toner ES, Branson RD, et al. Surge capacity logistics: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. CHEST. 2014;146(4_suppl):e17S-e43S.
15. David S. Handbook of Emergency medicine. 8 ed: Elsevier; 2012.
16. Satterthwaite P, Atkinson C. Using'reverse triage'to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster. Emerg Med J. 2012;29(2):160-2.
17. Van Cleve WC, Hagan P, Lozano P, Mangione-Smith R. Investigating a pediatric hospital’s response to an inpatient census surge during the 2009 H1N1 influenza pandemic. Jt Comm J Qual Patient Saf. 2011;37(8):376-82.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.