A scoping review of internal hospital crises and disasters in the Netherlands, 2000-2020.

Vincent W Klokman,Marieke G J Versteegen,Edward C T H Tan,Frits H M Van Osch,Menno I Gaakeer,Jaap J J Wijnands,Dennis G Barten,Arjen Boin,Nathalie A L R Peters

doi:10.1371/journal.pone.0250551

Abstract

BackgroundInternal hospital crises and disasters (IHCDs) are events that disrupt the routine functioning of a hospital while threatening the well-being of patients and staff. IHCDs may cause hospital closure, evacuations of patients and loss of healthcare capacity. The consequences may be ruinous for local communities. Although IHCDs occur with regularity, information on the frequency and types of these events is scarcely published in the medical literature. However, gray literature and popular media reports are widely available. We therefore conducted a scoping review of these literature sources to identify and characterize the IHCDs that occurred in Dutch hospitals from 2000 to 2020. The aim is to develop a systematic understanding of the frequency of the various types of IHCDs occurring in a prosperous nation such as the Netherlands.MethodsA systematic scoping review of news articles retrieved from the LexisNexis database, Google, Google News, PubMed and EMBASE between 2000 and 2020. All articles mentioning the closure of a hospital department in the Netherlands were analyzed.ResultsA total of 134 IHCDs were identified in a 20-year time period. Of these IHCDs, there were 96 (71.6%) emergency department closures, 76 (56.7%) operation room closures, 56 (41.8%) evacuations, 26 (17.9%) reports of injured persons, and 2 (1.5%) reported casualties. Cascading events of multiple failures transpired in 39 (29.1%) IHCDs. The primary causes of IHCDs (as reported) were information and communication technology (ICT) failures, technical failures, fires, power failures, and hazardous material warnings. An average of 6.7 IHCDs occurred per year. From 2000–2009 there were 32 IHCDs, of which one concerned a primary ICT failure. Of the 102 IHCDs between 2010–2019, 32 were primary ICT failures.ConclusionsIHCDs occur with some regularity in the Netherlands and have marked effects on hospital critical care departments, particularly emergency departments. Cascading events of multiple failures transpire nearly a third of the time, limiting the ability of a hospital to stave off closure due to failure. Emergency managers should therefore prioritize the risk of ICT failures and cascading events and train hospital staff accordingly.

Highlights

Emergency medical services and emergency departments (EDs) within hospitals are community-based resources responsible for the initial medical response to a wide variety of disasters [1]
A total of 134 Internal hospital crises and disasters (IHCDs) were identified in a 20-year time period
IHCDs occur with some regularity in the Netherlands and have marked effects on hospital critical care departments, emergency departments

Summary

Introduction

Emergency medical services and emergency departments (EDs) within hospitals are community-based resources responsible for the initial medical response to a wide variety of disasters [1]. Hospitals are less prepared for internal events resulting in the (potential) loss of vital medical infrastructural systems [2] When such an event occurs, we speak of an internal hospital crisis and/or disaster (IHCD), which we define as a sudden onset event that severely disrupts the everyday, routine services of a hospital facility. In popular parlance, these are referred to as “major incidents within hospitals”. The causes of IHCDs can be internal (e.g., information and communication technology (ICT) failure, sabotage, fire), and external (community-wide events such as natural disasters that affect the services of a hospital) [2].

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