With the depths of winter just around the corner, doctors and nurses everywhere know what's about to hit them over the next few months. The inevitable surge in hospital admissions during colder weather is almost as predictable as knowing the leaves will be falling off the trees in the fall. As someone who has worked in several different hospitals over the last few years, ranging from small rural institutions to large academic medical centers, I've rarely witnessed adequate preparations for the surge in activity that always occurs during December to March. Ironically too, many hospitals in the warmer south also experience a similar phenomenon, as "snowbirds" from the north head down to states such as Florida and South Carolina for the winter. Given this predictability, there's absolutely no reason for hospital administrations or physician groups to be caught off guard every year. Here's what they need to do: Physicians, particularly those in generalist specialties such as emergency and hospital medicine, should create special winter schedules -- with extra doctors working at the front lines. This should happen well in advance, and not at the last possible minute. Ditto above for nurses, especially on medical floors. On-call schedules may need to be adjusted to ensure more manpower, and everyone needs to be prepared to chip in to help. Bed contingency arrangements should be made, with detailed plans of where to "board" patients when hospitals run at full capacity. Can an extra floor be opened or are there any empty spaces or rooms to put patients? Coordinate with other healthcare facilities in the area (yes, even if they are technically rivals) to cope with even further unpredictable surges of patients -- like during a flu outbreak. Remember too, it's not just all about doctors and nurses either. All hospital departments need to set up detailed plans. The pharmacy, laboratory, physical therapy, food and housekeeping services -- are all part of the vital hospital structure! Ideally, hospital administrations and physician leaders should hold meetings in November or early December to discuss these contingency arrangements. With the aging population, planning for increased sickness during the adverse weather becomes more crucial and pertinent with each passing year. To prevent the chaotic scenes that unfold in thousands of hospitals up and down the country every winter, to quote Benjamin Franklin, the healthcare world needs to realize that by continuously failing to prepare, we are preparing to fail. And sadly, that means failing our patients. Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha Source
