Jim Garrow

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Feb 20, 2020

Over the course of my tenure at RPA, a Jensen Hughes Company, we’ve completed hundreds of Catastrophic Surge Assessments. While awareness of the risk for a catastrophic medical surge is increasing, it’s still not common practice to operationalize hospital surge plans and protocols to manage potentially overwhelming infection outbreaks.

Yale New Haven Hospital in New Haven, Connecticut is the exception. They have taken the tools that were developed during their Catastrophic Surge Assessment and established an operational surge program to assist them in managing their flu season. Over the past few years, they and other Connecticut hospitals have seen a marked increase of patients suffering from flu during the winter months and needed a solution to manage this recurring event.

As I mentioned in our last Surge Blog, as part of a Catastrophic Surge Assessment we identify:

  • Space: Specific areas that can be utilized in the event of a patient surge
  • Staffing: Staffing requirements for the identified surge areas
  • Stuff: Equipment such as beds, portable cardiac monitors and other required equipment to support the surge space

These are the building blocks to developing an Operational Surge Plan. In the case of Yale New Haven, the next step to build upon this was to develop the levels of a surge.

Levels of Catastrophe Surge

Surge levels were identified, and actions assigned to them.

During pre-surge, unit managers were required to understand what routine things they could do on a regular basis, which were easy to implement and created an increase in capacity.

Ahead of time, Yale New Haven assigned three tiers (Tier 1, Tier 2 and Tier 3) of surge depending on severity. These different Tiers (Tier 3 being the most severe), are thresholds within a Surge, which indicate how far over their normal occupancy they are. Each hospital department has their own threshold that is activated for each tier of response. When a surge was initiated, a Capacity Command Center was set up that strategized, coordinated, collaborated with all areas of the hospital. The following questions were posed to unit managers:

  • What changes to your standard operating procedures can you implement to make increasing capacity a focused effort in your department?
  • What are the stretch things that, as a last resort, you would do in order to focus all efforts on increasing patient throughput?

In the event of a discharge surge, where many patients were being released, the focus was how standard operating procedures were maintained and what changes were required.

Finally, guidelines were established to determine when the de-escalation of surge status should be considered.


The trigger points that New Haven established were based on historical data. For instance, a Tier 3 surge would only occur less than 1% of the time. Yale New Haven hospital used these trigger points to activate their medical surge plan and operational protocols.

Having the Proper Tools

Once they identified that surge beds were required, the next step was to identify clinical units. The Command Staff has a unit-specific tool that details what rooms can surge and what staffing and equipment will be required to support the surge. To identify surge space, they used the Command Center Tool—which provides a ranking of the surge space. To gain the most value from the tool, all identified surge beds were also entered into their Bed Board Management and Electronic Health Medical Record.

This detailed reporting and analysis has helped Yale New Haven respond proactively to operational surges. This planning has allowed them to save on resources and provide the best care possible to their patients with little downtime.

Yale New Haven’s case study illustrates how Catastrophic Surge preparation can also apply to seasonal Operational Surges – once you have the data to determine when a surge is about to take place, you can make thorough preparations to prepare your facility.