Hospital Incident Command System Research Articles

Lessons for tomorrow: The role of relationships and mindfulness in sustaining services during a crisis.

The COVID-19 pandemic placed unprecedented demands on hospitals around the globe, making timely crisis response critical for organizational success. One mechanism that has played an effective role in health care service management during large-scale crises is the Hospital Incident Command System. The aim of this article was to understand the role of HICS in the management of a large academic medical center and its impact on relationships and communication among providers in the delivery of services during a crisis. This mixed methods study was based on meeting observations, document reviews, semistructured interviews, and two measures of team performance within an academic medical center in the Northeast during the COVID-19 pandemic. Descriptive and bivariate analyses were applied, and qualitative data were coded and analyzed for themes. HICS provided a systematic information-sharing and decision-making process that increased communication and coordination among team members. Analyses indicate a correlation between dimensions of relational coordination and organizational mindfulness. Qualitative data revealed the importance of shared meetings and huddles and the evolution of HICS across multiple waves of the crisis. HICS facilitated organizational improvements during the crisis response and generated opportunities to maintain specific coordination practices beyond the crisis. The prolonged implementation of HICS during the COVID-19 pandemic created challenges, including the disruption of the routine leadership structure. Applying relational coordination and organizational mindfulness frameworks may allow hospitals to leverage communications and relationships within a high-stakes environment to improve service delivery.

Hospital preparedness assessment for road traffic accidents with mass casualties: a cross-sectional study in Kurdistan Province, Iran

BackgroundRoad traffic accidents (RTAs) are predicted to become the world’s seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC).MethodsThe study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals’ preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high.ResultsThe study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists.ConclusionEnhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region’s geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs.

Centering Health Equity in the Implementation of the Hospital Incident Command System: A Qualitative Case Comparison Study.

Disasters exacerbate inequities in health care. Health systems use the Hospital Incident Command System (HICS) to plan and coordinate their disaster response. This study examines how 2 health systems prioritized equity in implementing the Hospital Incident Command System (HICS) during the coronavirus disease 2019 (COVID-19) pandemic and identifies factors that influenced implementation. This is a qualitative case comparison study, involving semi-structured interviews with 29 individuals from 2 US academic health systems. Strategies for promoting health equity were categorized by social determinants of health. The Consolidated Framework for Implementation Research (CFIR) guided analysis using a hybrid inductive-deductive approach. The health systems used various strategies to incorporate health equity throughout implementation, addressing all 5 social determinants of health domains. Facilitators included HICS principles, external partnerships, community relationships, senior leadership, health equity experts and networks, champions, equity-stratified data, teaming, and a culture of health equity. Barriers encompassed clarity of the equity representative role, role ambiguity for equity representatives, tokenism, competing priorities, insufficient resource allocation, and lack of preparedness. These findings elucidate how health systems centered equity during HICS implementation. Health systems and regulatory bodies can use these findings as a foundation to revise the HICS and move toward a more equitable disaster response.

Abortion Care After the Dobbs Decision: An Academic Health System's Response to a Statewide Ban.

Indiana was the first state to pass legislation severely restricting access to abortion care following the Dobbs v. Jackson Women's Health Organization decision. Indiana Senate Enrolled Act 1 (SEA 1) outlaws all abortions with few exceptions. Indiana University Health (IU Health), the largest and only academic health system in the state, has a unique relationship with the Indiana University School of Medicine and a vision to improve the health of Indiana residents. IU Health employed the Hospital Incident Command System model to create a plan to ensure its patients continue to have access to safe, high-quality family planning, maternal, and neonatal care services and that clinicians are protected against criminal penalties and threats to personal safety. This article provides an overview of the Incident Command structure used to rapidly work across many disciplines, tackle complex issues, respond to concerns, and design and implement changes. The article also outlines the key considerations and decisions made by Incident Command leaders, such as where abortions that met the new law's criteria should be performed, changes to clinical workflows and protocols, and the creation of a rapid response team. The article then examines the operational, legal, and clinical challenges encountered by clinicians and health care team members, including a lack of peer support or idea sharing with other health systems in the state; accurate estimation of abortion, live birth, and neonatal intensive care unit volumes; and ambiguity in the law and lack of guidance from the state government. Recommendations regarding communication with clinicians and other health care team members and engaging information technology early are offered for health systems and medical schools that may face legislative barriers to health care delivery in the future. Finally, IU Health's commitment to tracking the impact of SEA 1 on patients, clinicians, employees, and the state is outlined.

Water safety planning for healthcare facilities for extreme events.

Disasters such as the Ahr Valley flood in 2021 make us aware of the importance of functioning healthcare facilities. Their functionality depends on the availability of drinking water. Water safety planning is a long-established method to increase the safety of water utilities. Our work supports the implementation of water safety planning in healthcare facilities during normal operations and emergency situations concerning the water supply. The authors conducted a stakeholder mapping exercise and problem awareness analysis. Based on these results, it was identified what is needed to overcome barriers to water safety planning (WSP). Building on existing procedures, the WSP concept, and latest scientific findings, an event-specific risk assessment method for healthcare facilities was developed and applied in a case study. Based on an analysis of water demand, water-related processes, and infrastructure, potentially necessary components for establishing an emergency supply were identified. For these, based on technical and legal requirements, planning principles were developed, and prototypes of components for emergency water supply were built. They were tested in pilot trials, particularly regarding hygienic safety. For the management of crises in hospitals, a survey was carried out on the command structures used in practice. Finally, recommendations were drawn based on the German Hospital Incident Command System.

Leadership Lessons in Crisis Management: A Case Study in Hospital Incident Command System in Response to Ebola Virus Disease

This article reviews the leadership lessons related to crisis management. A 402-bed licensed Level I academic trauma hospital was given eight hours notice to prepare to receive a patient under investigation for Ebola virus disease. The patient, who was returning to the United States from Uganda with fever, was referred to our hospital at the recommendation of the local city department of public health in consultation with the CDC. The leadership team set up a hospital incident command system and quickly put up a containment area in our emergency department. The leadership team applied Kotter’s eight-step change management model to help manage through the crisis. Emphasis was placed on using safety huddles and ensuring communication across the organization, led by the hospital incident command. Leadership was able to ensure accountability, efficiency, and the desired outcome by ensuring standard work, communicating across the organization, and engaging with the employees. The teams were successful: we ultimately were able to ensure the safety of the patient, healthcare workers, and the community while minimizing panic.

Designing and Validating a Training Model for the Staff of the Incident Command System in the Hospitals

Background. The main influencing factor in the success of the crisis management process is the group's readiness to deal with the crisis. Training models are a tool to maintain the preparation of personnel, increase their ability to achieve certain goals, and help them acquire information, skills, and ways of thinking. This research aimed to design and validate a training model for the staff of the hospital incident command system. Methods. The research method was a qualitative-quantitative (mixed method) approach. The statistical population in the qualitative part included experts in the field of incident command system, and in the quantitative part included managers and staff of this system in the hospitals of Guilan province in Iran. The sampling method in the qualitative part was the judgmental forecasting method. Also, the sampling method was cluster random in the quantitative part. According to the data saturation principle, the sample size in the qualitative section was 15 people, and in the quantitative section, 226 people were selected based on Cochran's formula. The data collection tool in the qualitative part was a semi-structured interview and in the quantitative part was a questionnaire extracted from the interview. Results. After analyzing the categories resulting from interviews with 15 experts, 43 open codes and 12 central codes were determined. Also, five selection codes were obtained as follows: design, analysis, evaluation and feedback, policymaking and determination of strategies, and implementation and support dimension. The findings showed that the design dimension had a more significant effect on designing the training model (path coefficient = 0.987 and t = 176.713). Also, all components had a significant relationship in pattern design. For data analysis, we used the MAXQDA2020 and SmartPls3 software in the qualitative part, and SPSS26 software in the quantitative part. Conclusion. The results of this research showed that effective command in possible incidents depends on the effective training of employees with a new and up-to-date model.

Leading a Hospital Incident Command System during a global pandemic.

Responding to a healthcare crisis such as COVID-19 requires a practiced, nimble incident command structure. Our medical center is in one of the areas in the US that was hardest hit by the initial wave. Effective leadership of incident command was critical in our response.

Investigating the Operational Management Challenges of a Reference Military Hospital in the COVID-19 Pandemic

"Introduction: Following the crisis of coronavirus outbreak in numerous regions of the world, this epidemic enhanced promptly in most countries, including Iran, and sent a host of patients in need of medical services to hospitals. This study aimed to investigate the challenges of operational management of a reference military hospital during the pandemic COVID-19. Methods: This research is a qualitative study with the content analysis method with a deductive and guided approach. Data collection was conducted through a semi-structured interview method and utilizing a questionnaire designed based on the management functions of the Hospital Incident Command System (HICS). The targeted sampling method and participants in this study included senior-middle managers working in organizational positions of the reference hospital in 2020 employed during the organizational position in Covid-19 Pandemic. Classifications and coding were performed employing MAXQDA 2018 software. Results: The findings of this study were explored in the form of strengths, weaknesses, and challenges. Weaknesses included taking surprise, early and non-missionary entry into the COVID-19 crisis, lack of appropriate depot, instant management, deficiencies in the training of patients and staff, poor functioning of the crisis management system, deficiencies in monitoring, and poor provision of psychological support. The strengths were the devoted and altruistic presence of the medical staff and managers, the financial support of the headquarters, the effective field research of the management team of the organization, and the proper management of the volunteer forces. The most significant challenge was the poor coordination with the relevant organizations, including the headquarters, the Defense Organization, and the Ministry of Health. Conclusions: The findings of this study demonstrate that in the peak period of the COVID-19 pandemic to promote the operational management of the hospital, sticking to the general policies of the organization, structured coordination with internal and external organizations, organized management of equipment and human resources, generating a robust documentation structure and decision-making based on the evidence, effective and practical use of the crisis management system, systematic training of staff and patients, prioritizing the safety of patients and staff, organized dissemination of information and systematic monitoring as well as evaluation are the most significant points to deal with the epidemic crisis. "

Incident management system comparison: Hospital Incident Command System versus Major Incident Medical Management and Support

Incident management system comparison: Hospital Incident Command System versus Major Incident Medical Management and Support

Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic.

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S's (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital's four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

Implementation of the Hospital Incident Command System during COVID-19 Pandemic; Experience from an Iranian Reference Hospital

Introduction: There is growing popularity of the Hospital Incident Command System (HICS) as an organizational tool for hospital management in the COVID-19 pandemic. We specifically describe implementation of HICS at the Isfahan province reference hospital (Isabn-e-Maryam) during the COVID-19 pandemic and try to explore performance of it. Methods: To document the actions taken during the COVID-19 pandemic, standard, open-ended interviews were conducted with individuals occupying activated HICS leadership positions during the event. A checklist based on the job action sheets of the HICS was used for performance assessment. Results: With the onset of the pandemic, hospital director revised ICS structure that adheres to span of better control of COVID-19. Methods of expanding hospital inpatient capacity to enable surge capacity were considered. The highest performance score was in the field of planning. Performance was intermediate in Financial/Administration section and good in other fields. Discussion: In the current COVID-19 pandemic, establishing HICS with some consideration about long-standing events can help improve communication, resource use, staff and patient protection, and maintenance of roles.

Effectiveness of Training the Hospital Incident Command System Chart at Chemical Disasters through Lecturing and Simulation Methods on Nurses’ Knowledge at Selected Military Hospitals of Aja

Effectiveness of Training the Hospital Incident Command System Chart at Chemical Disasters through Lecturing and Simulation Methods on Nurses’ Knowledge at Selected Military Hospitals of Aja

Investigating a cluster of pediatric oncology invasive fungal infections–Lessons learned

Background: In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive Rhizopus spp infections. An in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive Rhizopus spp was identified, resulting in an extended investigation for possible sources of fungus. Methods: A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping. Results: By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m3) of the same species of Rhizopus as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of Rhizopus was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas. Conclusions: No definite source was identified for the 4 invasive Rhizopus spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.Funding: NoneDisclosures: None

One committee to review it all: A single, multi-disciplinary COVID-19 research committee

On 1/20/2020 when the first case of a novel coronavirus (COVID-19) was confirmed in Washington state, its major impact was unknown. Memorial Sloan Kettering Cancer Center's (MSK) Hospital Incident Command System (HICS) was activated on 2/5, with our first COVID-19 case identified in early March. By 3/17, our Protocol Activation and Human Research Protection Program was fully remote and on 3/23, MSK leadership requested the creation of the COVID-19 Research Committee. Given the race to identify safe and effective treatments for COVID-19, modifications to workflows and review processes were needed. The goal was to provide quick access to COVID-19 treatments to our patients by creating a COVID-19 Committee as a “one-stop” committee, providing comprehensive review of clinical research related to COVID-19 including scientific review mandated by the Cancer Center Support Grant (CCSG) guidelines, prior to IRB review and protocol activation. Protocols that were reviewed by the COVID-19 Committee opened to accrual in an unprecedented 44 days from submission to the committee to open to accrual. Patients were accrued on most of the therapeutic protocols within 1 day of opening. These statistics have prompted our institution to explore how more protocols can benefit from this “one-stop” committee structure.

Hospital Management in Infectious Disease Outbreak: Lessons Learned From COVID-19 Epidemic

Background: Biological events, including epidemics, pandemics, and emerging and reemerging infectious diseases, have significant adverse consequences on human health. Hospitals have a major role in the management of outbreaks and mitigation of their consequences. During pandemics, health systems, especially hospitals, are affected. The current study aims to collect and analyze hospital lessons learned during the COVID-19 epidemic in Iran. Materials and Methods: The study data were collected through document analysis, direct observation, and taking the opinions of an expert panel (including hospital chiefs, hospital managers, disaster committee managers, matrons, and other hospital staff) at hospitals involved with coronavirus patients. Results: The practical measures performed in Iran hospitals included the development of the hospital incident command system, screening and triage, establishing a call center, patient and family management, personnel management, volunteers management, education, planning, safety, environmental health, dead patients management, sampling, food hygiene of staff and patients, coordination and cooperation, sharing information, home treatment and care, infection prevention, and control and isolation. Conclusion: COVID-19 pandemic has significant adverse consequences on human health, hospital, and medical staff. During COVID-19, hospitals will face a high surge in suspected and confirmed patients. Therefore, hospitals should perform the proper measures to manage an emergency.

Clinical profile and mortality among adult patients presenting with altered mental status to the emergency departments of a tertiary hospital in Tanzania: a descriptive cohort study.

IntroductionAltered mental status (AMS) in the Emergency Department (ED) can be associated with morbidity and mortality. In high income countries, mortality rate is under 10% for patients presenting with AMS. There is a paucity of data on the profile and mortality amongst this group of patients in limited income countries.Methodsthis was a prospective cohort study of adults ≥18 years presenting to the Emergency Departments of Muhimbili National Hospital (MNH) Upanga and Mloganzila in Tanzania with Altered Mental Status (AMS) unrelated to psychiatric illness or trauma, from August 2019 to February 2020. Patient demographic data, clinical profile, disposition and 7-day outcome were recorded. The outcome of mortality was summarized using descriptive statistics.Resultsamong 26,125 patients presenting during the study period, 2,311 (8.9%) patients had AMS and after exclusion for trauma and psychiatric etiology, 226 (9.8%) patients were included. The median age was 56 years (43-69 years) and 127 (56.2%) were male. Confusion 88 (38.9%) was the most common presenting symptom. Hypertension 121 (53.5%) was the most frequent associated comorbidity. The overall mortality was 80 (35.4%) within 7 days. Of 173 patients admitted to the wards, 54 (31.2%) died and of the 46 (20.4%) admitted to the intensive care unit (ICU), 20 (43.5%) died within 7 days. Six (2.7%) patients died in the emergency department.Conclusionpatients with AMS presenting to two EDs in Tanzania have substantially higher mortality than reported from Hospital Incident Command System (HICS). This could be due to underlying disease, comorbidities or management. Further research could help identify individual etiologies involved and high risk groups which can cater to better understanding this population.

CE: A Prone Positioning Protocol for Awake, Nonintubated Patients with COVID-19.

Prone positioning of critically ill patients with acute respiratory distress syndrome is an accepted therapy done to improve oxygenation and promote weaning from mechanical ventilation. But there is limited information regarding its use outside of the ICU. At one Boston hospital, the influx of patients with suspected or confirmed COVID-19 strained its resources, requiring sweeping systems changes and inspiring innovations in clinical care. This article describes how an interdisciplinary team of clinicians developed a prone positioning protocol for use with awake, nonintubated, oxygen-dependent patients with suspected or confirmed COVID-19 on medical-surgical units, with the hope of hastening their recovery and avoiding deterioration and ICU transfer. A protocol implementation plan and staff educational materials were disseminated via the hospital incident command system and supported through daily leadership huddles. Patient eligibility criteria, including indications and contraindications, and a clear nursing procedure for the implementation of prone positioning with a given patient, were key elements. Nurses' feedback of their experiences with the protocol was elicited through an e-mailed survey. Nearly all respondents reported improvements in patients' oxygen saturation levels, while few respondents reported barriers to protocol implementation. The prone positioning protocol was found to be both feasible for and well tolerated by awake, nonintubated patients on medical-surgical units, and can serve as an example for other hospitals during this pandemic.

Moving Forward from COVID-19: Organizational Dimensions of Effective Hospital Emergency Management.

Federal investment in emergency preparedness has increased notably since the 9/11 attacks, yet it is unclear if and how US hospital readiness has changed in the 20 years since then. In particular, understanding effective aspects of hospital emergency management programs is essential to improve healthcare systems' readiness for future disasters. The authors of this article examined the state of US hospital emergency management, focusing on the following question: During the COVID-19 pandemic, what aspects of hospital emergency management, including program components and organizational characteristics, were most effective in supporting and improving emergency preparedness and response? We conducted semistructured interviews of emergency managers and leaders at 12 urban and rural hospitals across the country. Through qualitative analysis of content derived from examination of transcripts from our interviews, we identified 7 dimensions of effective healthcare emergency management: (1) identify capable leaders; (2) assure robust institutional support; (3) design effective, tiered communications systems; (4) embrace the hospital incident command system to delineate roles and responsibilities; (5) actively promote collaboration and team building; (6) appreciate the necessity of training and exercises; and (7) balance structure and flexibility. These dimensions represent the unique and critical intersection of organizational factors and emergency management program characteristics at the core of hospital emergency preparedness and response. Extending these findings, we provide several recommendations for hospitals to better develop and sustain what we call a response culture in supporting effective emergency management.

Impaired psychological well-being of healthcare workers in a German department of anesthesiology is independent of immediate SARS-CoV-2 exposure - a longitudinal observational study.

Background: The study aimed to assess the mental well-being of healthcare professionals at a German department of anesthesiology and critical care with a specialized ICU for treatment of COVID-19 patients during the first two peaks of the 2020 pandemic, and identifying risk and protective factors.Methods: A single-center longitudinal, online-based survey was conducted in healthcare workers from a department of anesthesiology and critical care in Bavaria, the most affected federal state in Germany at the time of assessment. Validated scores for depression, anxiety, somatic disorders, burnout, resilience, and self-management were used and complemented by questions about perceived COVID-19-related stressors. In parallel, patient characteristics in the ICU were collected.Results: 24 and 23 critically ill COVID-19 patients were treated during both observation periods in April/May and November/December 2020, respectively. 87.5% and 78.2% of patients had moderate to severe acute respiratory distress syndrome. From March 6, 2020 onwards, the hospital had switched to a command and control-based hospital incident command system (HICS) and increased work forces. Point prevalence of depression-like symptoms (13.6% and 12.8%) and burnout (21.6% and 17.4%) in the department’s healthcare professionals was high. Exposure to SARS-CoV-2 did not increase psychological burden. Consequences of the lockdown were rated as highly distressing by a majority of all ICU personnel. High self-reported trait resilience was protective against signs of depression, generalized anxiety, and burnout.Conclusions: During the pandemic, healthcare professionals have been suffering from increased psychological distress compared to reference data for both the general population and ICU personnel. General effects of the lockdown appear more relevant than actual COVID-19 patient contact. High trait resilience has a protective effect, yet vulnerable individuals may require specific support. Prevention against potential after effects of the lockdown, and in particular measures allowing to avoid another lockdown, appear warranted.