The recent H1N1 pandemic presented severe challenges to many emergency departments (ED). At our institution it caused overcapacity issues with increasing length of stay and increasing patients leaving before treatment. The emergency department space at the hospital was already fully used including hallway beds. Other clinical space could not be taken for ED expansion, as it was also all maximally used.

Portable mobile ED expansion modules were developed consisting of ED supply carts, pharmacy items and a wireless ED information system (EDIS) integrated with computers on wheels. This EDIS provided internet access from anywhere in the hospital, enabling access to clinical databases, order entry for testing, medications and discharge instructions, providing full operability of ED functions. This complete assembly can be stored in a small storage area. The H1N1 pandemic allowed for practical testing of this system. This system was deployed to a nearby hospital clinic that closed at 5 pm. The expansion module operated from 6pm to 10pm staffed with two providers. Data was compared between days when the surge clinic was in operation and days it was not. Data was collected on patients seen and left without being seen rates.

During the trial period of 9 days, 1323 patients were seen in the ED and 112 were seen in the modular clinic setting, representing 8.5% of the total ED volume. No technical problems were noted and the system worked as designed. We observed increased satisfaction from both staff and patients. No reduction in the number of patients leaving without treatment was noted in either group (5/day).

A modular portable ED expansion setup is practical and may increase ED capacity at times of maximal patient volumes. These materials are easily storable and build surge capacity for other events.