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White Paper: An inside look at our Hospital Surge Plan

March 31, 2020
Published in: COVID-19

Staff wearing masks and talking outside of the hospital

As part of its standard Emergency Operations Plan, every hospital has a Surge Plan in place to deal with a sudden or extraordinary need for resources—beds, equipment and staff—due to a large increase in patient volume. Surge plans are implemented in phases as each facility's capacity, patient census and the acuity (or severity and complexity) of the cases evolve. Memorandums of understanding with facilities such as Augusta Expo, utilities and suppliers to handle surges have been in place for many years.

In October, 2019, before the COVID-19 pandemic, Augusta Health participated in a regional medical surge project involving 14 hospitals in a collaborative effort with the Northwest Regional Healthcare Coalition, to evaluate its ability to increase capacity by implementing a Hospital Surge Plan. A Fire and Emergency Management consultant from RPA, A Jensen Hughes Company, observed every unit at Augusta Health and provided recommendations about which areas could be converted and what additional resources might be needed. Augusta Health's rapid response to address and implement these recommendations last fall created a solid foundation for responding to the COVID-19 pandemic.

In response to the COVID-19 pandemic, these additional and specific Surge Planning issues are addressed:

How do we establish a potential patient volume?

Using evidence-based, well established predictive models for determining the prevalence of emerging diseases like COVID-19, Augusta Health's Incident Command Management Team meets twice daily to gauge the impact of COVID-19 on both the community and the hospital. The model considers population, demographics, incidence of disease and acuity to determine how many additional admissions there will be to the hospital and what resources will be required. Again, that volume changes daily, as more accurate information is added to the model. Based on the potential volume, units and resources are re-engineered to meet the predicted volumes.

Which units have been re-engineered?

Augusta Health has been fortunate to have had the time to proactively plan, prepare and re-engineer units for the expected surge of patients related to COVID-19. The Commonwealth of Virginia expects each hospital to be able to surge to at least 20% above its licensed bed census. Augusta Health's plans exceed that mandate; Augusta Health can surge to at least 50% above its licensed bed status in the hospital.

  • The first floor Surgical Unit and Joint Center have been re-engineered to be a specific Respiratory Care Unit. The entire first floor is a negative pressure zone.

  • The ground floor Skilled and Rehab Units will be re-engineered to take care of regular medical patients.

  • The Emergency Department has added 11 negative pressure rooms.

  • Between the Emergency Department and the inpatient areas, Augusta Health has added 32 additional isolation rooms for a current total of 50 isolation rooms at the hospital and converted the entire Waynesboro Urgent Care to isolation rooms.

  • Other units such as the Rehab Unit, the Post Anesthesia Care Unit and the Endoscopy Unit can be re-engineered to care for patients as needed.

  • A drive-thru testing facility is ready to be activated at the Waynesboro Urgent Care.

Planning also includes providing for separation of patients with respiratory illness from those with other medical conditions. These include separate triage areas and treatment zones in the Emergency Department; directing patients with respiratory symptoms to the Assessment Center at the Waynesboro Urgent Care and directing patients with other Urgent Care issues to alternative Urgent Care locations; and the separate units on different floors within the hospital.

How does Augusta Health stress test these plans?

A Surge Plan was developed more than a year ago to address high volumes of patients during flu season. Augusta Health stress-tested this plan several times over the past year. Stress testing began 'for real' this year when the Emergency Department when a high-volume flu season occurred. The ED Saturation Plan was activated when the department admissions escalated, so the entire staff at the hospital was aware and able to provide support as needed.

With new models and predictions for COVID-19, Augusta Health staff has adapted the Surge Plan to address COVID-19 patients.

For COVID-19, an algorithm has been developed that incorporates capacity, admissions to the hospital, discharges from the hospital, acuity of patients and bed status to determine if any phase of the Surge Plan needs to be activated. The algorithm is run twice each day.

How is staffing planned?

Augusta Health has investigated different models of care in order to staff the hospital during the COVID-19 outbreak. Because elective surgeries and procedures have been rescheduled, there is a labor pool of medical professionals that can be used in other areas. These include team nursing models, realigning staff so that certain specialties care for COVID-19 patients and other specialties are assigned to care for other medical patients and creating a "Medical Force" to be activated during surge. The staffing models have been completed and are ready to be used and adjusted as needed.

Sources: Personal interview with
  • William Doherty, MD, Vice President and Chief Medical Officer
  • Crystal Farmer, MSN, RN, NE-BC, Vice President and Chief Nursing Officer