Hospital Response Research Articles

How prepared are Canadian trauma centres for mass casualty incidents?

ObjectivesMass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response: physical assets (e.g., critical care beds, operating rooms, food, communication devices) as well as operating procedures (e.g., MCI committees, regional coordination, provider training). The purpose of this study is to provide an examination of MCI preparedness according to these categories in Level 1 Trauma Centre across Canada. MethodsThis study surveyed all Level 1 Trauma Centres across Canada in order to assess the physical assets and operating procedures they had in place in the event of a hypothetical MCI on one of the busiest days of the year for trauma care. ResultsOf the 28 Trauma Centres contacted, 13 completed surveys (46%). Most hospitals had sufficient food (9/13) water (9/13), fuel (7/13), and communication assets (8/13) for a hypothetical MCI. A median of 38 mechanical ventilators could be mobilized. No hospitals mandated physician training for MCIs, and 6/13 centres were certain that they had a Strategic Emergency Management Plan (SEMP). Only 6/13 hospitals had dedicated MCI committees, Overall, 4/13 hospitals had explicit plans developed with community hospitals. ConclusionThis study demonstrated that physical assets are generally less limiting than operating procedures. Four key areas of potential improvement have been identified: 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans.

KEBIJAKAN HUKUM PIDANA TERHADAP MALPRAKTIK MEDIS PADA RUMAH SAKIT

Malpractice still occurs a lot, both by hospitals and doctors, although there are several legal instruments that regulate hospitals, as well as medical practice with sanctions for violators of health laws. The purpose of this study is to explore the deficiencies that exist in legal policies, and to propose new legal policies in order to optimally prevent and overcome hospital malpractice. The research method used is a normative research method by examining aspects of criminal law in health law concerning malpractice, as well as theories and expert opinions for better legal policy proposals. From the qualitative analysis of primary and secondary legal material data, the following results were obtained: first, there are weaknesses in the health law policy so that it cannot prevent and overcome malpractice optimally, namely incompleteness and lack of clarity regarding the formulation of malpractice and its strict sanctions, as well as a turn towards acts against the law and the limitations of the hospital's responsibility for malpractice committed by doctors or medical personnel. Second, a new legal policy that can be proposed, namely by clearly formulating and detailing the limits of hospital malpractice in health law, accompanied by strict sanctions or accountability both criminal, civil, and administrative, the hospital is also responsible for malpractice committed by doctors with conditions in certain conditions, procedural law must be lex specialis by, for example, imposing strict liability.

A rural community hospital's response to COVID-19.

A rural community hospital's response to COVID-19.

Yulin Children's Hospital's Response to COVID-19 Epidemic Prevention and Control Measures and Effects

Objective: Introduce the prevention and control measures and effects during COVID-19, and provide a basis for strengthening the emergency response ability of children's hospitals to respond to public health emergencies.
 Methods: Introduced the epidemic prevention and control measures of the Children's Hospital of Yulin City, Shaanxi Province from January 22 to July 31, and summarize the prevention and control effects
 Results: During this period, according to the relevant national guidelines and regulations, the hospital established a reasonable hospital management model, formulated scientific prevention and control plans, and introduced effective prevention and control measures, realizing zero infection among front-line medical workers, zero spread of the epidemic in the hospital, and zero death among confirmed patients in the hospital.
 Conclusion: The prevention and control work of Yulin Children's hospital has comprehensive overall deployment and effective prevention and control measures, which has certain reference significance for the prevention and control work of large comprehensive children's specialized hospitals.

A Community Hospital's Response to the COVID-19 Pandemic.

The novel coronavirus 2019-nCoV (COVID-19) has disrupted and altered the way health care is delivered in the United States and across the world. Patient care guidelines and isolation recommendations continue to hastily change, demonstrating the key role of nursing professional development practitioners in educating and preparing frontline staff to provide safe patient care during the COVID-19 pandemic. This article describes a community hospital's strategic educational response to a highly contagious respiratory pandemic. Initiatives to increase staff education and conserve personal protective equipment are discussed.

A COVID-19 testing and triage algorithm for psychiatric units: One hospital's response to the New York region's pandemic

Psychiatric patients are at high risk for contracting COVID-19, and inpatient psychiatric units face substantial risks of institutional outbreaks. Here, the authors describe an algorithm for testing and triage in a large psychiatric facility designed to prevent local COVID-19 transmission. The algorithm is based on expert opinion and clinical experience between March and April of 2020, during which the institution cared for 47 COVID-19 positive psychiatric inpatients. The implementation of the algorithm is designed to mitigate COVID-19 transmission, preserve the safest and least restrictive treatment environment for psychiatric inpatients, and provide a model adaptable to other institutional settings.

Design and Impact of a COVID-19 Multidisciplinary Bundled Procedure Team.

Design and Impact of a COVID-19 Multidisciplinary Bundled Procedure Team.

Opportunities and Challenges for Resilient Hospital Incident Management: Case Study of a Hospital's Response to Hurricane Harvey

Communities face unforeseen threats from natural and human‐made disasters. As disasters grow more intense and critical infrastructure increases in complexity, resilience has emerged as an essential attribute of incident management systems. Despite concerted efforts to examine government organizations and their associated policies, understanding resilience traits exhibited by hospitals and healthcare systems during disasters is limited. We employ two fundamental viewpoints of safety to assess what went wrong (Safety I) and right (Safety II) during Hurricane Harvey in a large regional hospital. Through qualitative analysis of semi‐structured interviews with hospital emergency management and operators, we examine both opportunities and challenges in six aspects of hospital incident management: organizational structure and functions; situational awareness; operating plans; human and physical resources; lessons learned from previous incidents; and leadership and high‐level decision making. The benefits of incorporating both the Safety I and Safety II frameworks in evaluating hospital incident response and the implications of this approach for disaster management policies are discussed.

The impact of SARS-CoV-2 infection on the surgical management of colorectal cancer: lessons learned from a multicenter study in Spain.

the aim of the study was to analyze the management of colorectal cancer (CRC) patients diagnosed with CRC or undergoing elective surgery during the period of the SARS-CoV-2 pandemic. a multicenter ambispective analysis was performed in nine centers in Spain during a four-month period. Data were collected from every patient, including changes in treatments, referrals or delays in surgeries, changes in surgical approaches, postoperative outcomes and perioperative SARS-CoV-2 status. The hospital's response to the outbreak and available resources were categorized, and outcomes were divided into periods based on the timeline of the pandemic. a total of 301 patients were included by the study centers and 259 (86 %) underwent surgery. Five hospitals went into phase III during the peak of incidence period, one remained in phase II and three in phase I. More than 60 % of patients suffered some form of change: 48 % referrals, 39 % delays, 4 % of rectal cancer patients had a prolonged interval to surgery and 5 % underwent neoadjuvant treatment. At the time of study closure, 3 % did not undergo surgery. More than 85 % of the patients were tested preoperatively for SARS-CoV-2. A total of nine patients (3 %) developed postoperative pneumonia; three of them had confirmed SARS-CoV-2. The observed surgical complications and mortality rates were similar as expected in a usual situation. the present multicenter study shows different patterns of response to the SARS-CoV-2 pandemic and collateral effects in managing CRC patients. Knowing these patterns could be useful for planning future changes in surgical departments in preparation for new outbreaks.

Consideration and Practice on Hospital Incident Command System During Mass Casualty Incidents in Chinese Hospitals

Introduction:More and more hospitals are using the Hospital Incident Command System (HICS) for organizational management under emergency conditions. HICS is an incident management system based on principles of the Incident Command System (ICS), which assists hospitals and healthcare organizations in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. This study aims to explore how Chinese hospitals manage their organizations with HICS in Mass Casualty Incidents (MCI).Aim:To explore the feasibility of HICS in Chinese hospitals under MCI.Methods:A combination of literature analysis and empirical research was used in this study. Through case studies and experience summarization, the necessity and feasibility of the incident command system (ICS) and the emergency medical response system (EMRS) was demonstrated in the early stage of MCI. Based on this, a new "1 SECTION-5 GROUPS-10 TEAMS " model was proposed, and its value of practical application was discussed in MCI.Results:Multiple resources must be mobilized In MCI, and it is necessary to establish an ICS and an EMRS as soon as possible in the early stages of MCI. The earlier ICS is set up, the more initiative can be taken. The "1 SECTION-5 GROUPS-10 TEAMS" model proposed in this study has a good effect on the practice of drills and rescues, indicating that this model has a certain promotion effect in the hospital's response to MCI.Discussion:The "1 SECTION-5 GROUPS-10 TEAMS" model has high feasibility and can be further verified in the subsequent rescue practice.

Impact of cloud-based information sharing on hospital supply chain performance: A system dynamics framework

The inadequacies of traditional information sharing are amplified in the healthcare sector. Poor demand and inventory visibility result in demand and supply mismatch of healthcare products in ways that may have dire economic and patient care consequences. For instance, a hospital drug shortage often requires an emergency delivery. These emergency refills increase cost and may disrupt a patient's recovery process. In recent years, innovations in information technology have been leveraged to improve supply chain collaboration and move closer to matching supply with demand. In this article, we build on that body of research by examining cloud computing as an enabler of electronic supply chain management systems (e-SCMs) that enhances collaborative information sharing in a multi-echelon hospital supply chain. We use systems theory and system dynamics to develop two conceptual, causal loop diagrams (CLDs); one representing traditional and the other cloud-based information sharing in a hospital supply chain. CLDs and their equivalent system dynamics models are used to simulate the performance of traditional and cloud-based hospital supply chains. We compare the performance metrics of both models: average inventory levels, lead time, and unfilled orders. The findings of this study show that cloud-based information sharing improves visibility in healthcare supply chains. As supply chain visibility increases, a hospital's responsiveness improves. Hospitals are now in a better position to accommodate fluctuations in patient demand and supply lead times. As a consequence, hospital supply chains will experience reductions in inventory costs, supply costs, and supply shortages.

AN ANALYSIS OF HOSPITAL SERVICE USAGE TO INFORM RIGHTSIZING REGIONAL HOSPITALS

The new approach of the hospital development and reform in Romania, from the perspective of the National Health Strategy 2014-2020, focuses especially on the establishment of regional hospitals. The main concern in this process is connected to rightsizing this type of healthcare units, in order to further ensure proper functioning, from the very beginning of the design phase. To get the right number of beds reflected in the regional hospital sizing, we analyzed, starting from the Regional Health Service Plans, the usage of healthcare services across each of the eight administrative regions in Romania. Through this analysis, we intended to find in what way and to which hospital the patients are addressing, as well as the complexity of the hospitalized cases, thus establishing a pattern of usage. The most interesting element of the analysis was patients’ migration to hospitals situated in counties or regions different from those of their residence. Since the number of beds is also a determining factor for staffing as well as for providing a certain volume and type of services, we considered that the pattern of usage is the link between the expressed need for services and the hospital's response capacity. Following the analysis, we made a proposal for rightsizing the regional hospitals, based on one of four calculation variants. Keywords: hospital, healthcare service usage, patient migration, bed occupancy rates, rightsizing, demand forecasting . Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;}

Understanding Consumer Perceptions and Awareness of Hospital-Based Maternity Care Quality Measures.

To explore factors that may influence use of comparative public reports for hospital maternity care. Four focus groups conducted in 2013 with 41 women and preintervention survey data collected in 2014 to 2015 from 245 pregnant women in North Carolina. As part of a larger randomized controlled trial, we conducted qualitative formative research to develop an intervention that will be evaluated through pre- and postintervention surveys. Analysis of focus group transcripts examined participants' perceptions of high-quality maternity care and the importance of different quality measures. Quantitative analysis included descriptive results of the preintervention survey and subgroup analyses to examine the impact of race, education, and being a first-time mom on outcomes. When describing high-quality maternity care, participants focused on interactions with providers, including respect for preferences and communication. The importance of quality measures was influenced by the extent to which they focused on babies' health, were perceived as the hospital's responsibility, and were perceived as representing "standard care." At baseline, 28 percent of survey respondents had used quality information to choose a hospital. Survey respondents were more aware of some quality measures (e.g., breastfeeding support) than others (e.g., episiotomy rates). Public reporting efforts could help increase relevance of maternity care quality measures by creating measures that reflect women's concerns, clearly explaining the hospital's role in supporting quality care, and showing how available quality measures can inform decisions about childbirth.

Identifying Indirect Benefits of Federal Health Care Emergency Preparedness Grant Funding to Coalitions: A Content Analysis.

This study aimed to identify the indirect benefits of health care preparedness funding as perceived by current and former recipients of the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response's Hospital Preparedness Program. This was a qualitative inductive content analysis of telephone interviews conducted with regional stakeholders from several health care coalitions to identify their perceptions of the indirect benefits of preparedness funding. Content analysis of interviewee responses resulted in 2 main categories of indirect benefits of federal health care preparedness funding: (1) dual-use technology and programs and (2) impact of relationships on day-to-day operations. Within the dual-use technology and programs category, 3 subcategories were identified: (1) information systems, (2) clinical technology, and (3) health care operations. Similarly, 3 subcategories relating to the indirect benefits in the impact of relationships on day-to-day operations category were identified: (1) cooperation, (2) information sharing, and (3) sense of community. This study identified indirect benefits of federal investment in hospital and health care preparedness in day-to-day operations. Major categories of these benefits included dual-use technology and programs and impact of relationships on day-to-day operations. Coalition members placed a high value on these benefits, even though they were not direct outcomes of grant programs. Further research is needed to quantify the economic value of these indirect benefits to more accurately measure the total return on investment from federal grant funding.

From Acute Care to Home Care: The Evolution of Hospital Responsibility and Rationale for Increased Vertical Integration

The responsibility of hospitals is changing. Those activities that were once confined within the walls of the medical facility have largely shifted outside them, yet the requirements for hospitals have only grown in scope. With the passage of the Patient Protection and Affordable Care Act (ACA) and the development of accountable care organizations, financial incentives are focused on care coordination, and a hospital's responsibility now includes postdischarge outcomes. As a result, hospitals need to adjust their business model to accommodate their increased need to impact post-acute care settings. A home care service line can fulfill this role for hospitals, serving as an effective conduit to the postdischarge realm-serving as both a potential profit center and a risk mitigation offering. An alliance between home care agencies and hospitals can help improve clinical outcomes, provide the necessary care for communities, and establish a potentially profitable product line.

Multidisciplinary team response to a mass burn casualty event: outcomes and implications

To describe the characteristics of patients with burn injury admitted to a major trauma hospital in Melbourne following the Black Saturday bushfires of 7 February 2009, and to provide a detailed analysis of the hospital's response to the crisis. A retrospective chart review of ambulance and hospital records of patients admitted to the Victorian Adult Burns Service (VABS) at The Alfred Hospital (The Alfred) following the bushfires. Patient characteristics and outcomes: age, sex, total and full thickness body surface area burnt, type and site of burn, hospital and intensive care unit length of stay (LOS) and receipt of standard burn care practices. Estimated glomerular filtration rate, theatre time and LOS data for the bushfire cohort compared with corresponding data for historical cohorts from VABS and from a similar institution in New Zealand. Nineteen patients were admitted to VABS over the first 48 hours after the bushfires. Of these, nine patients were subsequently admitted to The Alfred's intensive care unit. Most patients (74%) were men with a mean age of 52.7 years (SD, 12.4 years). Seventeen patients (89%) underwent at least one surgical procedure, which resulted in 4355 minutes of theatre time for the bushfire cohort in the first week. Hospital LOS was similar for the bushfire and New Zealand cohorts. Compared with the VABS historical cohort, there was a higher incidence of abnormal renal function among the bushfire cohort patients. Although relatively few patients with severe burns were admitted to VABS, significant increases in resource allocation were required to manage them in terms of additional theatre time, consumables and staffing. The experience of VABS may aid planning for future mass burns casualty events.

The Nippon Medical School Hospital's Response to the Great East Japan Earthquake

The Nippon Medical School Hospital's Response to the Great East Japan Earthquake

Resilience Training for Hospital Workers in Anticipation of an Influenza Pandemic

Well before the H1N1 influenza, health care organizations worldwide prepared for a pandemic of unpredictable impact. Planners anticipated the possibility of a pandemic involving high mortality, high health care demands, rates of absenteeism rising up to 20-30% among health care workers, rationing of health care, and extraordinary psychological stress. The intervention we describe emerged from the recognition that an expected influenza pandemic indicated a need to build resilience to maintain the health of individuals within the organization and to protect the capacity of the organization to respond to extraordinary demands. Training sessions were one component of a multifaceted approach to reducing stress through effective preparation and served as an evidence based platform for our hospital's response to the H1N1 pandemic. The training was delivered to more than 1250 hospital staff representing more than 22 departments within the hospital. The proportion of participants who felt better able to cope after the session (76%) was significantly higher than the proportion who felt prepared to deal confidently with the pandemic before the session (35%). Ten key themes emerged from our qualitative analysis of written comments, including family-work balance, antiviral prophylaxis, and mistrust or fear towards health care workers. Drawing on what we learned from the impact of SARS on our hospital, we had the opportunity to improve our organization's preparedness for the pandemic. Our results suggest that an evidence-based approach to interventions that target known mediators of distress and meet standards of continuing professional development is not only possible and relevant, but readily supportable by senior hospital administration.

The Nippon Medical School Musashi Kosugi Hospital's Response to the Great East Japan Earthquake

The Nippon Medical School Musashi Kosugi Hospital's Response to the Great East Japan Earthquake

The Nippon Medical School Tama Nagayama Hospital's Response to the Great East Japan Earthquake

The Nippon Medical School Tama Nagayama Hospital's Response to the Great East Japan Earthquake