Preparing for the Maximum Emergency with a Simulation: A Table-Top Test to Evaluate Bed Surge Capacity and Staff Compliance with Training

Figures & data

Figure 1 Infographic sketching.

Table 1 Subjects Involved in the Fase 1 of the Study Divided by Area

105 subjects: 68 doctors on guard 36 nurses	Medical Area
	Nephrology Rheumatology
	Cardiology Pneumology
	General Medicine 1 General Medicine 2
	Gynecology
	Surgical Area
	General Surgery 1 General Surgery 2
	Vascular Surgery Urology
	Neurosurgery Pediatric Surgery
	Orthopedium Otolaryngology
	Intensive Therapy
	Resuscitation 1 RICU
	PACU
	Sub- intensive departments CCU Stroke Unit
1 Nursing Coordinator	OR DEA (3)

Table 2 The Six Categories A, B, C, D, E and F in Which Hospitalized Patients Have Been Stratified are Arranged in a Decreasing Order of Care Intensity in the Our Areas of Interest (Medical, Surgery, Bubintensive Care, Intensive Care)

A	Patient’s need for a high-intensity care
B	patient’s need for a intensity care equal to that provided at the time of detection one
C	Patients who are able to transfer to either a bed with a below-current level of care/intensity
D	Patients who are able to transfer in a hypothetical discharge-room
E	Patients who are able to transfer in a hospital with a lower intensity of care/rehabilitation structure
F	Patients who are able to safe home discharge

Table 3 The Five Categories I, II, III, IV, V in Which Patients Who Have to Undergo Surgery Have Been Stratified are Arranged in a Decreasing Order of the Possible Deferral of Surgery

I	Intervention not yet started, postponable
II	Intervention just started whose interruption is possible within a short time (< 1h)
III	Intervention started of which it is possible to stop it, but not soon (>1 h)
IV	Intervention started and already beyond, of which it is not possible to stop it due to surgical complexity and anesthesiological care
V	Intervention started or not, representing an urgency and not postponed

Table 4 Association Between the Proportion of Dismissible Beds and the Area: Results of the Logistic Regression Model (Intensive Care Units Set as the Reference), Globally for All the Simulation Waves

Area	OR	95% C.I. of OR	p value
Medical Area	5.87	3.14–10.98	< 0.001
Surgical Area	5.33	2.85–9.95	< 0.001
Subintensive Care Units	3.29	1.43–7.59	0.005
Intensive Care Units (ref)	1.00	–	–

Table 5 Subjects Involved in the Fase 2 of the Study Divided by Area

18 Subjects: 18 Nursing Coordinator	Medical Area
	Nephrology Rheumatology
	Cardiology Pneumology
	General Medicine 1 General Medicine 2
	Gynecology
	Surgical Area
	General Surgery 1 General Surgery 2
	Vascular Surgery Urology
	Neurosurgery Pediatric Surgery
	Orthopedium Otolaryngology
	Intensive Therapy
	Resuscitation 1 RICU
	PACU
	Sub-intensive departments
	CCU Stroke Unit
	OR DEA (3)

Table 6 Association Between the Proportion of Dismissible Beds and the Area Globally for All the Simulation Waves: All the Comparisons Between the Four Areas Analyzed are Reported

Area	OR	95% C.I. of OR	p value
Medical Area vs Surgical Area	1.10	0.78–1.56	1.000
Intensive Care Units vs Surgical Area	0.19	0.08–0.43	<0.001
Subintensive Care Units vs Surgical Area	0.62	0.27–1.41	0.733
Intensive Care Units vs Medical Area	0.17	0.07–0.39	<0.001
Subintensive Care Units vs Medical Area	0.56	0.25–1.28	0.381
Subintensive Care Units vs Intensive Care Units	3.29	1.07–10.13	0.031

Table 7 Association Between the Proportion of Dismissible Beds and the Area: Results of the Logistic Regression Model (Intensive Care Units Set as the Reference), Distinctly for Simulation Waves

Area	OR	95% C.I. of OR	p value
a) First simulation wave
Surgical Area	4.99	1.88–13.29	0.001
Medical Area	3.24	1.23–8.55	0.018
Subintensive Care Units	0.80	0.22–2.95	0.740
Intensive Care Units (ref)	1.00	–	–
b) Second simulation wave
Surgical Area	4.11	1.40–12.06	0.010
Medical Area	3.03	1.04–8.86	0.042
Subintensive Care Units	10.40	2.03–53.20	0.005
Intensive Care Units (ref)	1.00	–	–
c) Third simulation wave
Surgical Area	17.50	3.86–79.42	< 0.001
Medical Area	24.54	5.29–111.05	< 0.001
Subintensive Care Units	9.80	1.50–63.85	0.017
Intensive Care Units (ref)	1.00	–	–

Table 8 Association Between Proportion of Dismissible Beds and Unit at 2 Hours After Simulated Maxiemergency Assessment: Results of the Logistic Regression Model (Intensive Care Units Set as the Reference), Globally for All the Simulation Waves

Unit	OR	95% C.I. of OR	p value
Surgery	4.22	2.12–8.43	< 0.001
Ortopaedics	10.30	5.04–21.05	< 0.001
Pneumology	2.35	1.18–4.67	0.015
Intensive Care Units (ref)	1.00	–	–

Table 9 Association Between the Proportion of Dismissible Beds and the Unit Globally for All the Simulation Waves: All the Comparisons are Reported

Area	OR	95% C.I. of OR	p value
Ortopaedics vs Surgery	2.44	1.20–4.94	0.005
Pneumology vs Surgery	0.56	0.29–1.07	0.109
Intensive Care Unit vs Surgery	0.24	0.09–0.60	< 0.001
Pneumology vs Ortopaedics	0.23	0.11–0.46	< 0.001
Intensive Care Unit vs Ortopaedics	0.10	0.04–0.25	< 0.001
Intensive Care Unit vs Pneumology	0.43	0.17–1.07	0.089

Table 10 Association Between the Proportion of Dismissible Beds and the Unit Distinctly for Each Simulation Wave: Results of a Logistic Regression Models (Intensive Care Unit Set as Reference). a) First Simulation Wave; b) Second Simulation Wave; c) Third Simulation Wave

Unit	OR	95% C.I. of OR	p value
a) First simulation wave
Surgery	2.13	0.65–6.95	0.213
Ortopaedics	4.89	1.51–15.80	0.008
Pneumology	1.16	0.39–3.40	0.794
Intensive Care Unit (ref)	1.00	–	–
b) Second simulation wave
Surgery	3.82	1.15–12.71	0.029
Ortopaedics	7.28	2.22–23.88	0.001
Pneumology	0.87	0.25–2.98	0.821
Intensive Care Unit (ref)	1.00	–	–
c) Third simulation wave
Surgery	13.09	2.73–62.64	0.001
Ortopaedics	52.00	9.70–278.63	< 0.001
Pneumology	20.36	3.98–104.17	< 0.001
Intensive Care Unit (ref)	1.00	–	–

Table 11 Proportion of Not Dismissible and Dismissible Beds and ICD-10 Diagnostic Chapter

ICD 10 Diagnostic Chapter	Not Dismissible Beds (Code A, B)	Dismissible Beds (Code A, B, C, D)	Total
1 – Infectious diseases	19	20	39
	48.72	51.28	100.00
	5.85	2.89	3.83
2 - Tumors	53	50	103
	51.46	48.54	100.00
	1.31	7.23	10.13
3- Haematologic diseases	4	19	23
	17.39	82.61	100.00
	1.23	2.75	2.26
4- Endocrinological diseases	4	10	14
	28.57	71.43	100.00
	1.23	1.45	1.38
5 – Mental diseases	0	1	1
	0.00	100.00	100.00
	0.00	0.14	0.10
6 – Neurological diseases	4	10	14
	28.57	71.43	100.00
	1.23	1.45	1.38
8 – Otolaryngological diseases	3	2	5
	60.00	40.00	100.00
	0.92	0.29	0.49
9 – Circulatory diseases	68	190	258
	26.36	73.64	100.00
	20.92	27.46	0.49
10 – Respiratory diseases	60	73	133
	45.11	54.89	100.00
	18.46	10.55	13.08
11 – Gastrointestinal diseases	20	55	75
	26.67	73.33	100.00
	6.15	7.95	7.37
12 – Skin affections	3	4	7
	42.86	57.14	100.00
	0.92	0.58	0.69
13 – Skeletal muscle affections	10	42	52
	19.23	80.77	100.00
	3.08	6.07	5.11
14 – Genito-urinaty tract diseases	11	31	42
	26.19	73.81	100.00
	3.38	4.48	4.13
15 – Pregnancy	3	4	7
	42.86	57.14	100.00
	0.92	0.58	0.69
16 – Perinatal affections	0	2	2
	0.00	100.00	100.00
	0.00	0.29	0.20
17 – Congenital diseases	2	8	10
	20.00	80.00	100.00
	0.62	1.16	0.98
18 Symptoms and signs	14	36	50
	28.00	72.00	100.00
	4.31	5.20	4.92
19 – Traumatic injuries	30	102	132
	22.73	77.27	100.00
	9.23	14.74	12.98
20 – External causes	1	1	2
	50.00	50.00	100.00
	0.31	0.14	0.20
21 – Influential factors	16	32	48
	33.33	66.67	100.00
	4.92	4.62	4.72
	325	692	1017
	31.96	68.04	100.00
	100.00	100.00	100.00

Table 12 Conclusions

Conclusions
1. The availability of beds in the simulations is greater than the theoretical bed surge capacity indicated in the PEIMAF
2. Intensive and Sub-Intensive Areas limit the Hospital Bed Surge Capacity
3. Age is a parameter that influences the Bed Surge Capacity
4. The availability of DEA ORs are not a problem during an ME
5. The analysis of response times allowed to see how the compliance increased with the recurrence of the surveys.