Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study

Lancet. 2006 Dec 2;368(9551):1984-90. doi: 10.1016/S0140-6736(06)69808-5.


Background: The ability to provide medical care during sudden increases in patient volume during a disaster or other high-consequence event is a serious concern for health-care systems. Identification of inpatients for safe early discharge (ie, reverse triage) could create additional hospital surge capacity. We sought to develop a disposition classification system that categorises inpatients according to suitability for immediate discharge on the basis of risk tolerance for a subsequent consequential medical event.

Methods: We did a warfare analysis laboratory exercise using evidence-based techniques, combined with a consensus process of 39 expert panellists. These panellists were asked to define the categories of a disposition classification system, assign risk tolerance of a consequential medical event to each category, identify critical interventions, and rank each (using a scale of 1-10) according to the likelihood of a resultant consequential medical event if a critical intervention is withdrawn or withheld because of discharge.

Findings: The panellists unanimously agreed on a five-category disposition classification system. The upper limit of risk tolerance for a consequential medical event in the lowest risk group if discharged early was less than 4%. The next categories had upper limits of risk tolerance of about 12% (IQR 8-15%), 33% (25-50%), 60% (45-80%) and 100% (95-100%), respectively. The expert panellists identified 28 critical interventions with a likelihood of association with a consequential medical event if withdrawn, ranging from 3 to 10 on the 10-point scale.

Interpretation: The disposition classification system allows conceptual classification of patients for suitable disposition, including those deemed safe for early discharge home during surges in demand. Clinical criteria allowing real-time categorisation of patients are awaited.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bed Occupancy*
  • Decision Making, Computer-Assisted
  • Disaster Planning*
  • Emergency Medical Services / organization & administration*
  • Humans
  • Inpatients / classification*
  • Patient Discharge*
  • Professional Staff Committees / organization & administration*
  • Risk Assessment / methods*
  • Risk Assessment / organization & administration
  • Severity of Illness Index
  • Triage / methods*
  • Triage / organization & administration