Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care.
Pediatrics
; 119(1): 94-100, 2007 Jan.
Article
em En
| MEDLINE
| ID: mdl-17200275
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.
Buscar no Google
Coleções:
01-internacional
Temas:
Promover_ampliacao_atencao_especializada
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Qualidade da Assistência à Saúde
/
Unidades de Terapia Intensiva Pediátrica
/
Planejamento em Desastres
/
Hospitais Pediátricos
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Adolescent
/
Child
/
Child, preschool
/
Humans
/
Infant
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Pediatrics
Ano de publicação:
2007
Tipo de documento:
Article