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Highlights of Bed Surge Plan During National Emergency

When hospitals across the state increased bed capacity by 40%, Sierra View Medical Center (SVMC) exceeded the governor’s request and their three-phase surge plan was put into action. A multidisciplinary team of hospital leaders facilitated the development of the surge plan with consideration of all necessary patient safety measures and efficiency while maintaining healthy business operations of the organization.

The first of three phases were handled by clinical leaders who worked collaboratively to provide 26 additional beds for non-COVID patients in clinical areas. This first phase included transformations in the main area of the Intensive Care Unit (ICU) and the Medical Surgical holding unit. In addition, the Post-Anesthesia Care Unit (PACU) provided eight ICU beds for non-COVID patients.

In March, the first phase was quickly put into action and the newly transformed PACU designated for recovering non-COVID-19 patients opened. Christen Rosa, Director of Surgical Services was tasked with ensuring the PACU nurses had everything needed for patients to recover safely in the new area. Because the transformation was unlike anything taken on before, Christen had a lot of support from the remarkable charge nurses from recovery and surgery departments.

“In addition to my team’s efforts, infection prevention became a huge support as a thought partner to validate the processes we put in place,” said Christen Rosa. “Along with engineering, we came up with the plan to seal off the doors from the operating room to the PACU so the air was not exchanged.”

The objective of the overall surge bed plan was to utilize all available clinical area space before venturing into non-clinical spaces. SVMC has successfully been able to accommodate COVID-19 cases in the clinical areas utilizing phase one of the overall bed surge plan and have not yet not had to utilize conference rooms, which was part of phase two if the need was to arise.

Phase two of the plan includes altering large conference rooms on the first floor. In total, this would potentially provide 40 extra beds. There was a point in which anticipation of the surge prompted the start of clearing out a conference room to provide beds, but luckily nothing further had to be done. Unlike phase one, phase two presented an extra challenge where response teams would have had to travel further throughout the hospital when caring for patients.

“The challenges related to the second and third phases were logistical and financial,” said Traci Follett, Director of Clinical Informatics/Education, ACS. “In order to get non-clinical areas ready for patients, the planning was much more complex as we were starting from scratch and had to ‘recreate’ our clinical areas in spaces not designated for clinical work.”

The third phase includes scouting out outlying campus locations such as the Ambulatory and Surgery Center and other areas, which would provide 50 beds. Phase three would be immensely challenging as these are remote sites which require extra costly services such as environmental services and dietary.

“From room layout to flooring and water to electrical, among other things, the physical spacing alone had to be considered and potentially modified before we could even think about moving beds and clinical equipment and supplies into these areas,” Traci Follett added. “Additional challenges that were considered with the bed surge was staffing.”

As all hospitals faced similar challenges during the height of the pandemic, SVMC also had the same goal of keeping their patients, staff and community as safe as possible and pulled together a plan that evolved and was enriched over a short period of time. For now, SVMC will continue to operate within phase one, with the security of knowing that if phase two or three are needed, they are ready to handle the surge and provide top level care to the patients of SVMC.