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Surge Capacity and Surge Capacity and ED Crowding:ED Crowding:

Can we have one withoutCan we have one without fixing the other?fixing the other?

Susan Nedza MD, MBA, FACEPJanuary 10, 2003

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Imagining the the UnimaginableUnimaginable

September 11, 2001: The unasked September 11, 2001: The unasked question.question.

We are all vulnerable!We are all vulnerable! The anthrax experienceThe anthrax experience The key role of the emergency The key role of the emergency

department in each communitydepartment in each community

January 10, 2002 Susan Nedza, MD, MBA, FACEP

““I’m not worried about small I’m not worried about small pox, I’m worried about a pox, I’m worried about a bad flu season”bad flu season”

- - ED Director, New ED Director, New York StateYork State

Recognizing RealityRecognizing Reality

January 10, 2002 Susan Nedza, MD, MBA, FACEP

“ “ My Emergency Department My Emergency Department already is at ground zero- already is at ground zero- LA is the Chernobyl of the LA is the Chernobyl of the health care system.”health care system.”

- - ED DirectorED Director

Los AngelesLos Angeles

Recognizing RealityRecognizing Reality

January 10, 2002 Susan Nedza, MD, MBA, FACEP

“ “ I am not sure where I will I am not sure where I will find room for the next five find room for the next five patients, let alone five patients, let alone five hundred.” hundred.”

- - ED Director,ED Director,

Atlanta, GeorgiaAtlanta, Georgia

Recognizing RealityRecognizing Reality

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Defining Surge CapacityDefining Surge Capacity

ED capacityED capacity– providing safe, quality careproviding safe, quality care– bioterrorism preparednessbioterrorism preparedness– meeting local community needsmeeting local community needs– recognizing link to public health recognizing link to public health

needsneeds– changing medical practicechanging medical practice– meeting the EMTALA mandatemeeting the EMTALA mandate

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Defining Surge CapacityDefining Surge Capacity

Hospital capacityHospital capacity– critical care capacitycritical care capacity– nurse and other health professional nurse and other health professional

staffingstaffing– capacity for changing medical practicecapacity for changing medical practice– capacity to meet community needscapacity to meet community needs– strengthening links to public health strengthening links to public health

communitycommunity

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Defining Surge CapacityDefining Surge Capacity

Community capacityCommunity capacity– meeting needs of changing meeting needs of changing

demographicsdemographics– partnering with other institutionspartnering with other institutions– EMS system issuesEMS system issues– geographic considerationsgeographic considerations– communicating with all stakeholders- communicating with all stakeholders-

public and private public and private

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Defining Surge CapacityDefining Surge Capacity

Health system capacityHealth system capacity– meeting needs of changing meeting needs of changing

demographics- “The pig in the demographics- “The pig in the python”python”

– Long term care capacityLong term care capacity– Ensuring access to careEnsuring access to care– Caring for vulnerable populationsCaring for vulnerable populations– Allocating fixed resourcesAllocating fixed resources

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Linking Surge Capacity to Linking Surge Capacity to Quality and Safety Quality and Safety

ImperativesImperatives

The leadership imperativeThe leadership imperative Meeting local community needsMeeting local community needs Disaster planningDisaster planning

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Meeting the ChallengeMeeting the Challenge

Communications- managing Communications- managing demanddemand

Increasing Efficiency- managing Increasing Efficiency- managing through-put to create capacitythrough-put to create capacity

Increasing supply- health policy Increasing supply- health policy solutionssolutions

January 10, 2002 Susan Nedza, MD, MBA, FACEP

Creating ED Capacity for Creating ED Capacity for the Futurethe Future

The opportunity for planningThe opportunity for planning The opportunity for collaborationThe opportunity for collaboration The opportunity to redefine The opportunity to redefine

emergency careemergency care

January 10, 2002 Susan Nedza, MD, MBA, FACEP

ConclusionsConclusions

If we are to meet the challenge of If we are to meet the challenge of community preparedness for community preparedness for

bioterrorism events, we must first bioterrorism events, we must first meet the challenges of defining, meet the challenges of defining,

creating and managing capacity to creating and managing capacity to meet the present and future needs meet the present and future needs

for emergency care in every for emergency care in every community.community.