ACEP ED Staging Data Elements

Data Element	Description	Value range	Source	Evidence
Stage^	Numeric value assigned based on criteria for and values in related data elements	0-6	Derived from other data elements
Stage Name	Term that aligns with numeric stage value	baseline, initial phase, stressed, saturated, extreme, disaster, recovery	Determined by ACEP and assigned to stage
ED Capacity	Relative range of occupancy for given ED capacity	open, full (>35% Inpatient), saturated (>65% inpatient), saturated (100% inpatient), improving	Data that is reported to public health departments or through hospital reporting system	-ED throughput data (queueing theory) -See if there is an 85% capacity rule in the evidence -See also hospital overcrowding
Inpatient Capacity	Relative range of occupancy for given Inpatient capacity	open, full, >100% saturated, over saturated, improving	Data that is reported to public health departments or through hospital reporting system	-physical space (typically greater than staff avail) -staffing (need to consider nurse to patient ratio; 6-8 patients per nurse?)
Staff	Proportion of actual available staff to total available staff	available, minor shortages, shortages, serious shortages, improving	health system or is there some type of public data on this?	-bodies and skill sets (is the alignment right?) -for smaller EDs, smallest ratio between MD and pop is 5 (based on 2080 hours per year which is 52 weeks x 40 hours per week) -nurses per bed and total number of units
Supplies*	Proportion of actual available supplies to total available supplies	available, minor shortages, shortages, unavailable, improving	supply chain systems and health system	-check on this with supply chain orgs -dispensaries or log files (electronic or paper/manual) -labs are more managed -way to calculate with modeling
Equipment*	Proportion of actual available equipment to total available equipment	available, minor shortages, shortages, unavailable, improving	supply chain systems and health system	-central supply chain with requisition access

*Need to be defined on the basis of the situation

^Staging Details are in the table below

Stage	Description	Response	Evidence
0	Typical operations with seasonal fluctuations	Normal operation
1	Local cases emerge but handled in normal course of business	Preparation
2	Usual inpatient resources full	Full capacity protocol
3	Use of ancillary spaces for inpatient, e.g. post-op, surgical suites, OP areas	Expanded full capacity protocol; ED mostly cares for sick patients, MASH tents
4	Inpatient overflow into ED >65% impacting ED ops; scarce resources	FEMA response, use of alternative sites (e.g. Guard Armory); utilize military/National Guard personnel
5	System failure, no capacity for additional patients, resources exhausted	Comfort care, may decide to abandon pandemic cases to care for others
6	Drop in new cases, most of population has been infected	Begin to restore resources