Assessing Hospital and Health System Preparedness and Response

1
Assessing Hospital and Health System Preparedness
and Response

• Howard Levitin, M.D.
• Emergency Physician and Consultant
• Disaster Planning International

2
Level of Preparedness in Four Hospitals Surveyed

• None met minimum level of preparedness
• Only one center provided bioweapon (BW) training
• Only one facilitys plan addressed mass
  casualties
• All four hospitals regularly experience staffing
  problems
• Most had no excess capacity in the ED or ICU
• None had sufficient supplies to manage a mass
  casualty incident

3
Obstacles to Preparedness

• Lack of financial support for BW planning
  preparedness (typically volunteer)
• No generally accepted planning scenario
• Shortage of true planning/response expertise
• Minimal (or no) excess patient care capacity

4
Current Health of the Healthcare System

• Fewer hospitals
• Fewer hospital beds
• ED overcrowding
• Personnel shortage
• Resource limitations
• Financial instability

- Decreased by 1,075 1979-1999
- 378,000 decrease 1979-1999
- ED volume up 14
- Nurses, Pharmacists, etc.
- Just in time purchasing
- Decline in government support for hospitals
unfunded mandates increase demand for charity
care
5
To Measure Capacity, Hospitals must

• Evaluate existing immediately available
  services for inpatient outpatient care
• Assess its rapid expansion capacity physical
  plant, personnel, supplies equipment
• Consider maintenance of standards for medical
  care, monitoring tracking
• Consider contingency plans to ensure patient care
  alternative care centers, discontinuance of
  services patient transfers

6
Processes to Increase Capacity

• Early patient discharge
• Cancel elective procedures
• Open unused patient care areas
• Utilize non-traditional patient care areas
• Increase nurse/patient ratios

• Limiting factors
• Personnel
• Supplies
• Monitors/equipment
• Utilities
• Baseline demand for care doesnt change
• What will be the impact of the increased
  capacity?

7
Hospital Assessment

• Biological Emergency
• Planning Preparedness Questionnaire
• For
• Healthcare Facilities

• Clinical Preparedness Maturity Model
• Management Planning
• Information Technology
• Logistics
• Staff Skills
• Surveillance/detection

8
Public Health

• Lead agency in a biological attack
• Under reporting of infectious outbreaks
• Underutilized resource by medical providers
• Inadequate daily contact with community
  emergency resources
• Staff shortage especially Epidemiologists
• Not available 24/7

9
50 Anthrax PatientsBed Requirements
10
Yearly Impact of Influenza

• Seasonal effects
• Overcrowding ED, UCC, PPP, clinics
• ED diversion
• Prolonged wait times
• Bed shortages
• Overworked (sick) staff
• Scarcity of ventilators

• Excess hospitalizations 50/100,000
• 50 hospitalized gt65
• 20,000 die annually from the flu
• Direct costs -1B (1986)
• Indirect costs - 2-4B