Surge Capacity deployment in Hospitals : Effectiveness of Response and Mitigation Strategies

Major hospitals frequently lack adequate space to accommodate emergency patients. Managers can take actions to create surge capacity, an immediate additional supply of medical services to accommodate increased demand. We study operational strategies that improve surge capacity, and we identify how they can be deployed most effectively based on the characteristics of individual hospitals.Recent government regulations in the United States have increased pressure on hospitals to improve emergency preparedness. Specifically, hospitals must be able to show that they have taken adequate measures to manage surge capacity. We formulate an optimization model of early disposition actions that can be used to create surge capacity in a hospital. We analyze the model to understand its structural properties and compare two strategies to improve surge capacity: coordinated early discharge, which occurs during the response, and inpatient workload smoothing, which can help mitigate the need for response actions. We show analytically that without coordination, hospitals always act too conservatively in discharging patients to accommodate surge arrivals, and that smoothing the elective inpatient workload reduces the expected cost of surge response. In the numerical study, we find a utilization sweet spot in which smoothing is best at increasing surge capacity, and we show coordination increases the number of surges and number of early discharges, while smoothing mitigates these effects, making surges less frequent and less costly. Coordination is effective at increasing surge capacity for all types of hospitals, but when considering the holistic impact to the hospital, coordination and workload smoothing are often complementary strategies for improving surge response. Moreover, hospitals with sufficiently many electives and moderately high utilization should prioritize mitigation efforts when planning for emergencies