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Assessing Hospital and Health System Preparedness and Response

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Assessing Hospital and Health System Preparedness and Response Howard Levitin, M.D. Emergency Physician and Consultant Disaster Planning International – PowerPoint PPT presentation

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Title: 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 Patients Bed 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
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