Discharging the Healthiest From Hospital -- MEDICA - World Forum for Medicine

Led by Gabor Kelen, M.D., head of emergency medicine at The Johns Hopkins Hospital, a nationwide blue-ribbon panel of health care experts concluded that all hospitalized patients at any given time should be routinely ranked according to how sick they are and assigned a constantly updated "score" based on their vital signs, present condition and prognosis. That number would put them at a moment’s notice into risk groups that would rapidly inform decisions to discharge them or send them to another facility should a major disaster occur.

In one common disaster response, medical centres would set up additional beds wherever they can (in hallways, cafeterias, etc.). But, concerned that staffing levels could not expand to care for so many new patients, the authors of the study say "disposition classification" is a must.

"Without this sort of system in place, the worry is that a hospital’s resources would be quickly overwhelmed in a major crisis," says Kelen. "So not only would the disaster victims not get adequate treatment, but neither would the patients who are already hospitalized."

The system Kelen and the other panelists envision puts patients in one of five categories, based on their considered risk of a life-threatening or life-impairing medical problem within 72 hours of hospital discharge. Patients classified as "minimum" risk could go home upon being discharged. Those in the “low-risk” group could also be transferred home depending on the severity and scope of the disaster.

Those in the "moderate" category could not go home but could be transferred to a facility offering basic medical resources. "High-risk" patients could only be transferred to an acute-care facility and "very high-risk" patients could only be served in a critical care facility. Only a score-card system can "take the emotion" out of the decision-making process in the midst of a major disaster, Kelen notes.

MEDICA.de; Source: Johns Hopkins Medical Institutions