Large-scale implementation of a critical care surge capacity management program

Introduction

In 2003 the outbreak of severe acute respiratory syndrome (SARS) in some jurisdictions around the world highlighted a number of areas in healthcare planning that could be improved for dealing with such disasters. In Canada, one of the noted system challenges was the significant impact that an increase in the number of critically ill patients had on access to care and to other hospital services. Many jurisdictions have undertaken large-scale pandemic planning; however, there is a paucity of tools available to help hospitals deal with the day to day challenges of surges in patient volumes. As part of a larger comprehensive Critical Care Strategy designed to improve access to care, improve the quality of care and improve health system integration, and in partnership with hospitals and healthcare workers, the Ontario Ministry of Health and Long-Term Care designed and implemented a critical care Surge Capacity Management Program.

Methods

A review of the literature was completed to determine existing models for surge capacity planning. Surges were then classified as minor, moderate or major, depending upon the increase in demand above available services and the length of time a surge situation persisted. A framework was built to incorporate surge planning on five key elements: management, physical space, human resources, equipment and technology, and processes. A demonstration project to test the model was carried out in 18 hospitals. Hospitals collected data on patient flow processes across the organization in conjunction with daily data capture in the Critical Care Information System. Based on initial success, the program was approved for a province-wide implementation.

Results

Critical Care Surge Resource Teams that included front-line care providers, and a senior team sponsor and a physician champion were formed to implement surge capacity plans using the standardized framework and tools. Hospitals developed plans to handle minor surges that involved increasing to 115% above their normal operating capacity. This program has involved 201 critical care units in 150 hospitals across the province.

Conclusions

This program represents one of the largest implementations of a standardized Surge Capacity Program for managing critical care resources in a time of crisis. The program has seen practical use during the recent experience with H1N1 with improved access to care for patients.