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Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events

  • Gabor D. Kelen, Melissa L. McCarthy, Chadd K. Kraus, Ru Ding, Edbert B. Hsu, Guohua Li, Judy B. Shahan, James J. Scheulen and Gary B. Green...


Objectives: US hospitals are expected to function without external aid for up to 96 hours during a disaster; however, concern exists that there is insufficient capacity in hospitals to absorb large numbers of acute casualties. The aim of the study was to determine the potential for creation of inpatient bed surge capacity from the early discharge (reverse triage) of hospital inpatients at low risk of untoward events for up to 96 hours.

Methods: In a health system with 3 capacity-constrained hospitals that are representative of US facilities (academic, teaching affiliate, community), a variety (N = 50) of inpatient units were prospectively canvassed in rotation using a blocked randomized design for 19 weeks ending in February 2006. Intensive care units (ICUs), nurseries, and pediatric units were excluded. Assuming a disaster occurred on the day of enrollment, patients who did not require any (previously defined) critical intervention for 4 days were deemed suitable for early discharge.

Results: Of 3491 patients, 44% did not require any critical intervention and were suitable for early discharge. Accounting for additional routine patient discharges, full use of staffed and unstaffed licensed beds, gross surge capacity was estimated at 77%, 95%, and 103% for the 3 hospitals. Factoring likely continuance of nonvictim emergency admissions, net surge capacity available for disaster victims was estimated at 66%, 71%, and 81%, respectively. Reverse triage made up the majority (50%, 55%, 59%) of surge beds. Most realized capacity was available within 24 to 48 hours.

Conclusions: Hospital surge capacity for standard inpatient beds may be greater than previously believed. Reverse triage, if appropriately harnessed, can be a major contributor to surge capacity. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S10–S16)


Corresponding author

Address correspondence and reprint requests to Dr Gabor D. Kelen, Professor and Chair, Department of Emergency Medicine, 1830 E Monument St, Suite 6-100, Baltimore, MD, 21287(e-mail:


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Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
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