I'm presently working on terminology to help classify what is being counted in various measures for Beds, Ventilators and other equipment for The SANER Project.
As I look at the classifications that others are using:
Physical Capacity: Total number of beds (or other things being counted)
This breaks down in two different ways, by licensure and staffing.
Licensure:
Licensed Capacity: Number licensed (interesting but not important in emergency cases)
Surge Capacity: Number of additional that can be added in overflow situations.
Staffing:
Staffed Capacity: What has staff to support treatment.
Unstaffed Capacity: What does not have staff to support treatment.
Type of location:
A Bed is located in a part of a hospital (or similar facility) and is intended to support:
Inpatient care - Beds meant for patients with acute disease, but not needing emergency treatment. Inpatient care includes patients admitted for "Observation". They aren't well enough to return home, but they aren't sick enough to require a higher degree of attention. The distinction between Inpatient and Observation is generally a billing distinction, not one that truly addresses other characteristics of location.
Acute care: A subtype of inpatient care that provides for treatment of patients with care, but not intensive.
Intensive care: A subtype of inpatient care, providing a higher level of care, treatment and staffing than acute care.
Critical care: Some institutions have a level of care between Acute and Intensive which has higher staffing levels and treatment needs that normal acute, but lower than "Intensive". Cardiac care units and critical care units fit into this category. For the current situation, we think that CCU (whether cardiac or critical care) should fit into the Intensive care category when counting.
Burn Units: A burn unit is a specialization of an ICU that supports those needing treatment for burns (heat or chemical). These have additional equipment needed to treat patients who have significant loss of skin due to burns (e.g., cooling baths, higher temperature controls, and additional treatment resources). Such units might be used to treat patients who need ICU for which a normal ICU is not available, but this is not ideal use of resources. There's some question about whether these should be counted the same as ICU beds or differently from ICU beds. For the current crisis, this question may not be able to be answered. There will be crises in the future where this distinction is critically important.
Emergency care - Emergency beds are those meant to treat patients who have urgent or emergent
care needs which must be addressed before admission (or discharge to home or another location for treatment.
Post-Acute care - Other facilities also provide spaces for treatment of non-acute disease, which I would describe as care needed to support rehabilitation and recovery, or long-term care.
Outpatient care - Outpatient care beds include those meant for patients who are recovering from a procedure, or in other similar situations. See rooms below.
Other hospital facility space includes:
Operating rooms - facilities for performing surgical procedures.
Procedure rooms - facilities for performing other procedures (usually diagnostic).
Recovery rooms - facilities for treating patients recovering from surgery or other procedures that do not need post-procedure acute care.
These spaces may be reconfigured in emergency to support other uses.
Beds may be designated to treat patients within a certain age group:
Neonatal care beds (Nursery, NICU) are designed to support newborns and infants. They cannot be readily used to treat older children or adults, simply due to size limitations.
Pediatric care beds are designed to address the needs of children. They might be used to treat adults in cases of emergency.
Adult care beds are designated to address the needs of adults. They can be used to treat children in cases of emergency.
Many reasons for the distinctions between adult and pediatric beds are to address the different needs of these two populations when staffing and resourcing and planning the facility, rather than physical capacity restrictions (unlike the situation for neonatal care).
In Use/Available/Unavailable
Beds and other assets are either available or in-use or otherwise not available (broken, missing, on loan, et cetera). When being counted according to current guidelines, nobody seems to have addressed the "not available yet not-in-use" state.
Supplies (test kits, masks) are either on-hand (available for use), consumed (used for their intended purpose), disposed of (e.g., due to contamination, transfer to another location, or otherwise). For test kits, we need to distinguish between "test kits" which do the actual diagnostic test, and "specimen collection kits" which are used to collect and safely transport the specimen from the collection location to the testing facility. A shortage of either can cause problems. We also need to clarify the type of specimen used (blood vs. nasal or other swab) b/c sending a blood sample to a site that can only test via swab isn't going to help.
For equipment, we see discussion around ventilators and ventilator slots. We should be counting both in some way if both are in use. Adding slots to a ventilator (treating two or four patients with one ventilator) is being done today. It's a modification of a medical device that should only be done under specialized scruitiny and only in emergencies, but it is being done in New York at this stage.
There should be some clarity around how these are counted, because if people start thinking about how to redeploy ventilators to support patients, and one facility is counting slots and another counting ventilators, that's a problem. I'd suggest to "count ventilators" when talking about equipment, and count slots when talking about patients.
There's also the distinction between invasive ventilator (those requiring a tracheal tube), an non-invasive ventilation (CPAP and BiPAP), and also between those that are designed for long-term use and solutions that are coming out of the maker/innovator community which are specifically designed as "surge capacity devices."
As I look at the classifications that others are using:
Physical Capacity: Total number of beds (or other things being counted)
This breaks down in two different ways, by licensure and staffing.
Licensure:
Licensed Capacity: Number licensed (interesting but not important in emergency cases)
Surge Capacity: Number of additional that can be added in overflow situations.
Staffing:
Staffed Capacity: What has staff to support treatment.
Unstaffed Capacity: What does not have staff to support treatment.
Type of location:
A Bed is located in a part of a hospital (or similar facility) and is intended to support:
Inpatient care - Beds meant for patients with acute disease, but not needing emergency treatment. Inpatient care includes patients admitted for "Observation". They aren't well enough to return home, but they aren't sick enough to require a higher degree of attention. The distinction between Inpatient and Observation is generally a billing distinction, not one that truly addresses other characteristics of location.
Acute care: A subtype of inpatient care that provides for treatment of patients with care, but not intensive.
Intensive care: A subtype of inpatient care, providing a higher level of care, treatment and staffing than acute care.
Critical care: Some institutions have a level of care between Acute and Intensive which has higher staffing levels and treatment needs that normal acute, but lower than "Intensive". Cardiac care units and critical care units fit into this category. For the current situation, we think that CCU (whether cardiac or critical care) should fit into the Intensive care category when counting.
Burn Units: A burn unit is a specialization of an ICU that supports those needing treatment for burns (heat or chemical). These have additional equipment needed to treat patients who have significant loss of skin due to burns (e.g., cooling baths, higher temperature controls, and additional treatment resources). Such units might be used to treat patients who need ICU for which a normal ICU is not available, but this is not ideal use of resources. There's some question about whether these should be counted the same as ICU beds or differently from ICU beds. For the current crisis, this question may not be able to be answered. There will be crises in the future where this distinction is critically important.
care needs which must be addressed before admission (or discharge to home or another location for treatment.
Post-Acute care - Other facilities also provide spaces for treatment of non-acute disease, which I would describe as care needed to support rehabilitation and recovery, or long-term care.
Outpatient care - Outpatient care beds include those meant for patients who are recovering from a procedure, or in other similar situations. See rooms below.
Other hospital facility space includes:
Operating rooms - facilities for performing surgical procedures.
Procedure rooms - facilities for performing other procedures (usually diagnostic).
Recovery rooms - facilities for treating patients recovering from surgery or other procedures that do not need post-procedure acute care.
These spaces may be reconfigured in emergency to support other uses.
Beds may be designated to treat patients within a certain age group:
Neonatal care beds (Nursery, NICU) are designed to support newborns and infants. They cannot be readily used to treat older children or adults, simply due to size limitations.
Pediatric care beds are designed to address the needs of children. They might be used to treat adults in cases of emergency.
Adult care beds are designated to address the needs of adults. They can be used to treat children in cases of emergency.
Many reasons for the distinctions between adult and pediatric beds are to address the different needs of these two populations when staffing and resourcing and planning the facility, rather than physical capacity restrictions (unlike the situation for neonatal care).
In Use/Available/Unavailable
Beds and other assets are either available or in-use or otherwise not available (broken, missing, on loan, et cetera). When being counted according to current guidelines, nobody seems to have addressed the "not available yet not-in-use" state.
Supplies (test kits, masks) are either on-hand (available for use), consumed (used for their intended purpose), disposed of (e.g., due to contamination, transfer to another location, or otherwise). For test kits, we need to distinguish between "test kits" which do the actual diagnostic test, and "specimen collection kits" which are used to collect and safely transport the specimen from the collection location to the testing facility. A shortage of either can cause problems. We also need to clarify the type of specimen used (blood vs. nasal or other swab) b/c sending a blood sample to a site that can only test via swab isn't going to help.
For equipment, we see discussion around ventilators and ventilator slots. We should be counting both in some way if both are in use. Adding slots to a ventilator (treating two or four patients with one ventilator) is being done today. It's a modification of a medical device that should only be done under specialized scruitiny and only in emergencies, but it is being done in New York at this stage.
There should be some clarity around how these are counted, because if people start thinking about how to redeploy ventilators to support patients, and one facility is counting slots and another counting ventilators, that's a problem. I'd suggest to "count ventilators" when talking about equipment, and count slots when talking about patients.
There's also the distinction between invasive ventilator (those requiring a tracheal tube), an non-invasive ventilation (CPAP and BiPAP), and also between those that are designed for long-term use and solutions that are coming out of the maker/innovator community which are specifically designed as "surge capacity devices."
0 comments:
Post a Comment