2005 NDMS Conference May 3, 2005 Session 53

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2005 NDMS Conference - May 3, 2005Session 53
National Hospital Available Beds for Emergencies
and Disasters (HAvBED) System A Demonstration
Real Time National Hospital Bed Availability
SystemFunded by the Agency for Healthcare
Research and Quality

• Stephen V. Cantrill, MD, FACEP

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The Problem of Bed Availability

• Local and regional bed availability is chronic
  problem in Emergency Medicine on a daily basis.
• Bed availability is a concern during periods of
  heightened potential need or when a patient surge
  capacity need develops.
• Response to AHRQ task order request to develop,
  implement and evaluate a real-time electronic bed
  tracking/monitoring system that augments a
  system/regions ability to care for surge
  patients.

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Basic Tenets

• Build upon what others have done.
• Build upon what others are currently using.
• Minimal disruption
• Minimal new training
• Utilize current user interfaces whenever possible
• Utilize current day-to-day practices and data
  gathering
• Minimize additional end-user work.
• Appreciate the risk of increasing complexity
• Decreased usability
• Decreased compliance
• Perceived as yet another Unfunded Mandate

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HAvBED Advisory Group

• Department of Health Human Services
• Agency for Healthcare Research and Quality
• Office of the Assistant Secretary for Public
  Health Emergency Preparedness
• Hospital Resources and Services Administration
• Department of Defense
• Office of the Assistant Secretary of Defense for
  Health Affairs
• USTRANSCOM
• USNORTHCOM
• Department of Homeland Security
• National Disaster Medical System
• Federal Emergency Management System
• Office of Veterans Affairs
• NY OEM, AHA, CDHAM/USUHS
• AHRQ IDSRN (Integrated Delivery System Research
  Network) Partners

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Data Reporting Partners
HERDS New York State Department of
Health Hospital Emergency Response Data System
Hospital Capacity Website

• Individual Participating Hospitals

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Project Goals

• Develop an interface to collect real-time
  electronic bed-tracking and other medical
  response resource data from currently available
  systems and through an individual hospital
  interface.
• Test and evaluate feasibility of this integrated
  system.

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Objectives

• Define, through expert consensus, bed capacity
  and standards for consistent counting.
• Produce an analysis of available information from
  reporting/monitoring systems currently in use and
  incorporate essential elements from these systems
  into a single interface.
• Develop a mechanism to collect and report bed
  availability data to Federal, State and Local and
  other defined regions medical emergency planners
  and responders.

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Objectives (cont.)

• Integrate a GIS spatial display into the
  developed system.
• Test and evaluate the system.
• Identify the data elements and interface
  requirements for transporting, tracking, and
  reporting patient status.

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Existing Bed Tracking Systems
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System Diagram
Federal, Regional and Local Planners and
Responders (Data Display)
Individual Hospital Interface (Manual Data
Entry)
Website (Secure Access)
Web Services
Firewall
DATABASE
EMSystem
Arizona Colorado Hawaii Kansas Kentucky Missouri N
evada New Mexico Oklahoma Hospitals
State Hospital Capacity Web System
HERDS
New York
Oregon South Carolina Washington Hospitals
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Software RequirementsSpecifications

• Externalization of proposed system operation
• Includes brief definition of data elements
• Outlines user interaction
• Shared with our data reporting partners
• Does not include detail of computer to computer
  communication (see XML Schema)

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Definitions

• Attempt to bring a degree of common understanding
  to users and participants
• Shared with data reporting partners
• Will be shared with institutions doing manual
  entry

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Definitions

• Vacant/Available Beds Beds that are vacant and
  to which patients can be immediately transported.
  These must include supporting space, equipment,
  medical material, ancillary and support services
  and staff to operate under normal circumstances.
  These beds are licensed, physically available and
  have staff on hand to attend to the patient who
  occupies the bed.
• Unless otherwise stated, in the HAvBED
  project, Current Beds Available refers to
  Vacant/Available Beds.

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Definitions - Other Beds

• Licensed Beds The maximum number of beds for
  which a hospital holds a license to operate. Many
  hospitals do not operate all of the beds for
  which they are licensed.
• Physical Available Beds Beds that are licensed,
  physically set-up and available for use. These
  are beds regularly maintained in the hospital for
  the use of patients, which furnish accommodations
  with supporting services (such as food, laundry,
  and housekeeping). These beds may or may not be
  staffed but are physically available.

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Definitions - Other Beds

• Staffed Beds Beds that are licensed and
  physically available for which there is staff on
  hand to attend to the patient who occupies the
  bed. Staffed beds include those that are occupied
  and those that are vacant.
• Unstaffed Beds Beds that are licensed and
  physically available that have no current staff
  on hand to attend to a patient who would occupy
  the bed.
• Occupied Beds Beds that are licensed, physically
  available, staffed and occupied by a patient.

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Definitions
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The Types of Beds to be reported to the HAvBED
Project include

• Adult Intensive Care (ICU) Beds that can support
  critically ill/injured patients, including
  ventilator support
• Medical/Surgical Also thought of as Ward beds
• Burn Burn ICU beds, either approved by the
  American Burn Association or self-designated.
  (These beds are NOT to be included in other ICU
  bed counts)
• Pediatric ICU As for Adult ICU, but for
  patients 17 years and younger
• Pediatrics Ward Medical/Surgical beds for
  patients 17 and younger

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The Types of Beds to be reported to the HAvBED
Project include

• Psychiatric Ward beds on a closed/locked
  psychiatric unit or ward beds where a patient
  will be attended by a sitter.
• Negative Pressure/Isolation Beds with negative
  airflow providing respiratory isolation. NOTE
  This value may represent available beds included
  in the counts of other types.
• Operating Rooms An operating room that is
  equipped, staffed and could be made available for
  patient care in a short period of time.
• These terms are recommendations only

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Future Bed Estimates

• 24hr Beds Available This value represents an
  informed estimate for each bed type as to how
  many vacant (staffed, unoccupied) beds above the
  current number could be made available within 24
  hours. This would include created institutional
  surge beds as well as beds made available by
  discharging/transferring patients.
• 72hr Beds Available This value represents an
  informed estimate for each bed type as to how
  many vacant (staffed, unoccupied) beds above the
  current number could be made available within 72
  hours. This would include created institutional
  surge beds as well as beds made available by
  discharging/transferring patients.

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Other Data to Be Reported

• Emergency Department Status
• Open Accepting patients by ambulance
• Closed Not accepting patients by ambulance
• Decontamination Facility Availability
• Available The institution has
  chemical/biological/radiological patient
  decontamination capability
• Not Available The institution is unable to
  provide chemical/biological/radiological patient
  decontamination

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Other Data to Be Reported

• Ventilators
• Available The number of ventilators that are
  present in the institution but are currently not
  in use and could be supported by currently
  available staff
• In Use The number of ventilators currently in
  use for patient care

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EDXL Emergency Data EXchange Language

• To attempt to define a National Incident
  Management System (NIMS)-compliant data exchange
  specification
• Sponsored by the non-profit Emergency
  Interoperability Consortium
• Facilitated by the ComCARE Alliance
• Both worked on CAP (Common Alerting Protocol) now
  being implemented by DHS, NOAA, DOJ
• Technical support from the Disaster Management
  eGov Initiative

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EDXL Emergency Data Exchange Language

• Proposed initial set of standardized messages
  for
• Incident Report
• Resource Request
• Resource Report
• Resource Dispatch
• Mass Care Report
• Intelligence Report
• XML (EXtensible Markup Language) based
• Proposed specifications will be submitted for
  stakeholder and industry review and formalization

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EDXL Emergency Data Exchange Language

• Initial HAvBED specifications/definitions have
  been solicited by the working group as a starting
  point
• XML Communication Schema (draft) has been
  developed
• Will allow straight-forward webservices
  communication

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Sample - HAvBED XML Schema

• ltxselement name"bedCapacity" minOccurs"0"gt
• Specify status, availability, baseline and
  capacity counts for each of the bed types.
• ltxscomplexTypegt
• ltxselement name"adultICU" type"rsBedCapacity"
  minOccurs"0"gt
• ltxsannotationgt
• Capacity status for adult ICU beds. These can
  support critically ill or injured patients,
  including ventilator support.
• lt/xselementgt
• ltxselement name"medicalSurgical"
  type"rsBedCapacity" minOccurs"0"gt
• ltxsdocumentationgt Capacity status for
  medical-surgical beds. These are also thought
  of as ward beds.
• lt/xselementgt
• ltxselement name"burn" type"rsBedCapacity"
  minOccurs"0"gt
• ltxsannotationgt
• ltxsdocumentationgtCapacity status for burn
  beds.lt/xsdocumentationgt
• lt/xsannotationgt

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Next Steps

• Completion and refinement of interface
• Validity testing
• Two 1 week demonstration periods of heightened
  reporting
• Preparation of final report
• (Demonstration system will no longer be
  operational after June 30, 2005)

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Questions / Discussion?