Surge Capacity: High census affects us all, staff video

Surge Capacity is a new institution-wide process to focus on timely movement of patients through their hospital stay, assuring patient safety in the midst of sustained high census.

Watch a video of the Nov. 7 Surge Capacity Summit.

Does the hospital feel extra busy to you? It has been! At University of Iowa Hospitals and Clinics, we’ve sustained high census for over two years. This has created significant and lasting stress for the emergency department, as well as many inpatient units and ancillary services.

Enter the Surge Capacity team: more than 20 nurses, physicians, administrators, and ancillary staff members who have developed a process to mitigate the effects of high census on our patients.

The team immediately recognized that high census disproportionately affects different departments and units at different times. The emergency department bears the brunt of overwhelming traffic, and some units receive many patients from operating rooms. Meanwhile, other units may be calmer, with some open beds. Institution-wide awareness of the issue is crucial to alleviating the problem, and clear communication between departments and units is crucial to the optimal use of all our resources to facilitate timely patient throughput.

“The goal is to assure that we have a universal language about sustained high census that everyone understands,” says Joelle Jensen, MSN, RN, NEA-BC, director, throughput and patient flow. “If we look at our 4 p.m. census for the last two months, we’ve been at ‘Level 5’ in the ED 17 percent of the time. And all units were at ‘normal’ just one day out of ten.”


In addition to opening the communication channels, the team developed specific criteria that would trigger specific action steps. Those criteria have been grouped into easily understood levels, which are determined by patient census and capacity:

  • Level 1: Normal
  • Level 2: Elevated
  • Level 3: Stressed
  • Level 4: Crisis
  • Level 5: An extreme level used only for the emergency department

The specific clinical areas that are part of Surge Capacity include behavioral health, adult critical care, pediatric critical care, obstetrics, adult acute care, pediatric acute care, surgery, and the emergency department. Each of these areas has been assigned specific action steps to take when the patient census grows.

At Level 1, it’s “business as usual.” At Level 2, staffing issues at the unit level may be addressed, with an increased focus on discharging patients who are ready to leave. Level 3 widens the scope of concern, enlisting the help of administrative staff to focus on throughput and smart staffing, and canceling or rescheduling non-essential meetings and activities. At Level 4, it’s all hands on deck, with staff and units working together to maximize capacity, streamline patient discharge, and stay focused on efficiency.

“If appropriate action steps are taken at Levels 2 and 3, we’re much less likely to get to Level 4,” says Jensen. Through every level, staff maintains concentration on giving each patient the exceptional compassionate care they expect from UI Hospitals and Clinics. Jensen hopes to see Surge Capacity steps become second nature to staff, with automatic actions that effectively address the potential crisis.

All of us working together make an extraordinary difference in the lives and care of our patients. The Surge Capacity process helps us step up our game to make a significant difference to our co-workers and the function of our institution.

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