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The Scottish Government has incorporated an AHRQ-funded tool into its latest pandemic influenza guidance. "Pandemic Influenza: Surge Capacity and Prioritisation of Health Services" is a key pandemic flu document designed for use by Scottish planners in the National Health Service and related organizations across Scotland. Scotland's population of 5.1 million people is served by approximately 4,700 primary care practitioners, and there are about 200 hospitals providing a range of services from acute to long-term care.

Billy Renfrew of the Pandemic Influenza Coordination Team of the Scottish Government in Edinburgh says, "As a result of the guidance [from the AHRQ-funded "Disposition Classification System"], more detailed work has been undertaken with practitioners on surge management in the event of a pandemic. We feel that the inclusion of this work is important in our planning on both the national level and in assisting responders to develop local plans."

The concept of "reverse triage," or the identification of inpatients for safe, early discharge, is seen as a way to create additional hospital surge capacity during a disaster or other high-consequence event. The concept was developed as part of the AHRQ-funded tool that is now incorporated as an integral part of the Scottish Government's guide in the section on discharge from a service or level of care.

AHRQ-funded researchers at Johns Hopkins University developed the "Disposition Classification System" that categorizes inpatients according to suitability for immediate discharge on the basis of risk tolerance for a subsequent consequential medical event. The idea behind reverse triage is that the identification of patients or clients for safe, early discharge may be necessary. Reverse triage (or "risk-balance early discharge") is a means of allowing a refocus of resources to those in even greater need.

Says Renfrew, "One of the benefits of the guidance has been increased engagement with clinicians on the practicalities, legal aspects, and ethics of patient and service prioritisation during a pandemic."

The tool was developed under the direction of Gabor Kelen, MD, Chair, Department of Emergency Medicine at Johns Hopkins University. Kelen also serves as Director of the Johns Hopkins Office of Critical Event Preparedness and Response and Director of the National Center for the Study of Preparedness and Catastrophic Event Responses, also at Johns Hopkins.

The pandemic influenza guidance can be found on the pandemic influenza Web site of the Scottish Government at (). The information related to Kelen's AHRQ-funded tool is under Section 9.3.