Planning for a Medical Surge: 5 Best Practices

A healthcare emergency occurs when the demand for patient care exceeds a facility’s capacity to provide it. One such crisis, known as a medical surge, occurs when a significant event creates a need that surpasses an organization’s baseline capabilities.

Before the COVID-19 pandemic, this phenomenon was often referenced primarily in terms of emergency and critical care departments. Now, amid increasing global disasters and system-wide staff shortages, it’s more broadly recognized that all healthcare organizations should be actively planning for surge mitigation and disaster management.

If you’re looking for ways to keep your patients (and staff) safe during times of unprecedented operational demand, this guide can help. Here, you’ll find answers to key questions about this specific type of disaster response, alongside five best practices for readying your facility. By implementing these recommendations, you’ll be better equipped to quickly mitigate a surge event while maintaining the standards of care your patients rely on.

What Is a Surge in Medical Terms?

If you’re wondering whether a facility’s maximum capacity refers to the volume of patients vs. the complexity of patients, you’re right to wonder. The simplest answer to the question, What is a surge (medically speaking)? is that it accounts for whatever is causing patient requirements to outpace the available therapeutic coverage.

This means a healthcare surge could arise even if the patient volume hasn’t increased beyond a facility’s norm, as long as their acuity demands more intervention than what the system is equipped to handle. Yet, a surge could also occur when the patient volume goes beyond the expected maximum, even if individual acuity levels are lower.

What Is a Medical Surge vs. a Patient Surge?

Medical, emergency, and patient surges are largely interchangeable terms when discussing healthcare strain, but each term focuses on a different aspect of the event. Therefore, the distinctions lie in what each term emphasizes.

Medical Surge

This term may be used in two ways. It often refers to the system-level limitations, like staff availability, bed limitations, or inadequate resources. However, some use it to indicate that the surge’s cause is medical in nature (driven by a viral outbreak or emerging disease, for example).

Emergency Surge

The term emergency surge is another reference to the root cause. In this case, the focus is on the external, precipitating event (like a wildfire or mass-casualty event).

Patient Surge

The patient surge definition focuses strictly on volume. It’s referring to the spike in a facility’s caseload or admissions that exceed the standard operational capacity.

Surge Capacity

Another important term to know is surge capacity. Definitions may vary institutionally, but essentially, surge capacity refers to an organization’s ability to handle a surge event. It’s a reference point for how a facility intends to meet extraordinary demand.

What Causes Healthcare Surge Events?

Any significant event can spark a surge across healthcare facility types if it causes more patients to seek care than what the receiving organizations can typically manage. Recent real-world examples of these types of precipitating disasters include:

• Mass illness (such as annual flu outbreaks and the COVID-19 pandemic).
• Natural disasters (including wildfires, hurricanes, and earthquakes).
• Major community events (like a summer outdoor concert that induces widespread heat stroke).
• Mass violence (such as an active shooter event).

The Significance of Medical Surge Capacity in Disaster Management

Safe, effective care during a disaster depends on a well-thought-out healthcare (or hospital) surge plan. Examples of why planning for additional surge capacity is a critical aspect of crisis management are examined below.

Planning for a Medical Surge: 5 Best Practices

Surge capacity is an essential aspect of any emergency operation plan within patient settings. Although planning can be complex (many large facilities use a tiered approach to surge planning), these five recommendations are some of the key considerations for helping facilities at any level keep patients and staff safe during a surge event.

1. The Time for Training Medical Staff Is Now

It’s important to involve staff in all emergency planning that strengthens surge capacity. By hosting education events that teach them the emergency triage strategy (and how to implement it), they’ll be ready to deliver emergency care as soon as disaster strikes.

Tips:

• Test the communication and disaster notification system routinely. Consider collecting data on staff response times — and their ability to assist within a certain timeframe — to guide further planning.
• Assign and clarify roles as part of surge training and education requirements. By pre-assigning staff roles, disaster communication and workflow can be optimized despite non-optimal conditions.

2. Encourage Alternate Pathways to Access Care

Especially for acute care facilities, it’s important to ensure that only the patients with true acute needs are contributing to patient volume. However, across facility types, organizations should leverage technology and partners to divert patients to the safest, most appropriate option. That may include telemedicine, a lower acuity care provider, or at-home management if the illness is minor enough.

Tips:

• Invest in virtual or remote care services and telephone lines with text capability to increase accessibility beyond the facility. This can help free beds for the patients who truly need them.
• Ongoing community outreach about the importance of vaccines, primary care intervention, and symptom management and oversight is critical to mitigating the healthcare impacts of cold and flu seasons.

3. Prioritize Healthcare Resource Stewardship

Surge capacity is inherently linked to a facility’s ability to increase or conserve essential healthcare resources. These resources can be further broken down into space, staff, and supply considerations. By taking care of all three during standard operations, facilities can better ensure their availability when an emergency does arise. Beyond this, there needs to be a plan for conserving these critical resources for only those who require them during a surge event.

Tips:

• Use an interactive tool like DASH (Disaster Available Supplies in Hospitals) for assistance around supply management. Although that specific tool was formulated with hospitals in mind, its resources are applicable across many care settings.
• Consider temporarily altering the nursing care delivery model in use to one that maximizes staffing efficiency and requires the least amount of staff per patient during the emergency situation. For example, a facility that uses the total care model may consider using the functional model to handle a surge’s strain.

4. Strategize for Quick Increases in Bed Availability

This involves planning for increased staffing in addition to freed beds or patient rooms. Integrate partnering facilities’ volunteer (and trained) staff to inflate access beyond the borders of your own facility (or to onboard more staff assistance on-site). There are numerous ways to strategize an increase of the capacity for care delivery beyond setting up beds in hallways.

Tips:

• Accelerate discharges (safely, and where able) to increase bed availability for patients with higher needs. This may mean leveraging community partners to send stable patients to a less acute setting, or back home if the appropriate assistance is available.
• Partner with local agencies like neighboring military bases. Many are equipped with (and trained to stand up) temporary structures that could facilitate additional space as needed.

5. Review and Revise After Every Healthcare Surge

Surges will happen, whether they’re minor (like during a seasonal viral outbreak) or major (due to a natural disaster, for instance). Gather staff feedback after these events and use it alongside meaningful objective data to direct future planning considerations and surge mitigation efforts.

Tips:

• Review nursing quality indicator data to identify and later target care standards that may have slipped during the crisis. This can shape how care is delivered and emergency standards are implemented during future events.
• Don’t restrict feedback surveys to in-house staff. Engage the wide spectrum of participants, including those from outside emergency medical services, local law enforcement, and others. Their insight may be invaluable to maintaining positive, productive relationships going forward.

Transform Systemic Challenges Into Organizational Growth

Medical surge planning is only one aspect of a robust emergency operation plan. For additional crisis considerations, our facility guides and expert-backed recommendations can help you ensure that your patients and team members experience the best possible outcomes, even during unprecedented situations.