Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events. Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.

Were our hospitals prepared to face the COVID-19 epidemic?

Background: The rapid spread of coronavirus disease 2019 (COVID-19) has become a major challenge for hospitals, which plays a key role in local and national responses to different emergencies and disasters, including the outbreak of communicable diseases.Objectives: This study aimed to determine the readiness of selected hospitals in one of the provinces of Iran in response to the COVID-19 epidemic.Methods: In this descriptive, analytical, and cross-sectional study, we used a checklist developed by the World Health Organization for the COVID-19 pandemic to assess the readiness of hospitals. We assessed and compared the readiness of four hospitals and used Microsoft Excel 2013® to collect and analyze the data.Results: The present results showed that the hospital, which was the main referral center for COVID-19, was in good conditions. However, other hospitals needed to increase their preparedness for the COVID-19 epidemic.Conclusion: Besides the importance of hospital readiness to respond to natural and man-made disasters, these institutions and health policymakers should be also prepared to respond properly to the outbreak of highly contagious diseases.

A national survey of hospital readiness during the COVID-19 pandemic in Nigeria

Introduction The COVID-19 pandemic continues to overwhelm health systems across the globe. We aimed to assess the readiness of hospitals in Nigeria to respond to the COVID-19 outbreak. Method Between April and October 2020, hospital representatives completed a modified World Health Organisation (WHO) COVID-19 hospital readiness checklist consisting of 13 components and 124 indicators. Readiness scores were classified as adequate (score ≥80%), moderate (score 50–79.9%) and not ready (score <50%). Results Among 20 (17 tertiary and three secondary) hospitals from all six geopolitical zones of Nigeria, readiness score ranged from 28.2% to 88.7% (median 68.4%), and only three (15%) hospitals had adequate readiness. There was a median of 15 isolation beds, four ICU beds and four ventilators per hospital, but over 45% of hospitals established isolation facilities and procured ventilators after the onset of COVID-19. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff welfare (50%) and availability of critical items (47.7%). Conclusion Most hospitals in Nigeria were not adequately prepared to respond to the COVID-19 outbreak. Current efforts to strengthen hospital preparedness should prioritize challenges related to surge capacity, critical care for COVID-19 patients, and staff welfare and protection.

Cesarean delivery rates, hospital readiness and quality of clinical management in Ethiopia: national results from two cross-sectional emergency obstetric and newborn care assessments

Background Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in Ethiopian CD rates, readiness of hospitals to provide CD and quality of clinical care, while highlighting the role of hospital management authority. Methods This secondary data analysis draws from two national cross-sectional studies to assess emergency obstetric and newborn care. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 women whose CD chart was reviewed in 2008 and 568 in 2016. Descriptive statistics are used to describe our primary outcome measures: population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management, including the relative size of Robson classification groups. Results The national population CD rate increased from 2008 to 2016 (< 1 to 2.7%) as did all regional rates. Rates in 2016 ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in private for-profit hospitals in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and private for-profit hospitals. Only half of the women whose charts were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9 to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, 40% of chart reviews from public hospitals were among low-risk nulliparous women (Robson groups 1&2). Conclusions Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool.

Hazardous materials and CBRN incidents: Fundamentals of pre-hospital readiness in the State of Qatar

Background: Hazardous Materials and Chemical/Biological/Radiological/Nuclear (HazMat-CBRN) incidents represent a serious threat to the population and the environment. They require a pre-hospital medical response system well equipped and supported with logistics and clinicians with appropriate knowledge and skills to prevent exposure and mitigate risks. Our aim is to determine if the Hamad Medical Corporation Ambulance Service (HMCAS) fulfils the pre-hospital readiness requirements for such incidents. Methods: This cross-sectional study was performed in HMCAS. An online survey assessed staff behaviour and knowledge in relation to HazMat-CBRN incidents. Responses were obtained on health risks and pre-hospital medical management of related threats in Qatar. Based on the results, a training module “HazMat Incident Management” was prepared with pre-/post-activity assessments. The results were explored using a multivariate linear regression and non-parametric Wilcoxon test for paired samples. Specialized Emergency Management (SEM) staff opinion about this training was assessed through an online survey. Both surveys’ validity and reliability tests were conducted. Ishikawa cause and effects diagram was built for the identification of the factors leading to a pre-hospital successful response to HazMat-CBRN incidents. Results: HMCAS has the proper logistics and plans to manage potential HazMat-CBRN incidents. The knowledge survey demonstrated that the pre-hospital medical staff information about this topic needs reinforcement. The multivariate linear regression and non-parametric Wilcoxon test demonstrated that this was obtained thanks to the implemented training module. The course satisfaction survey showed not only a big interest in this activity but also staff recommended more related topics. Earlier-RSDAT (Recognition, Safety, Decontamination, Antidot, Transport) is a tool proposed as a response acronym to build a successful risk-based response for HazMat CBRN incidents in pre-hospital setting. Conclusion: HMCAS fulfills the readiness requirements for safe and effective response to potential HazMat-CBRN incidents in Qatar. The RSDAT response matrix might help in mitigating pre-hospital response risks.

Essential Emergency and Critical Care - a consensus among global clinical experts

Background Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients can be overlooked in health systems. Essential and Emergency Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low-cost and low-complexity for the identification and timely treatment of critically ill patients across all medical specialities. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19. Methods A Delphi process was conducted to seek consensus (>90% agreement) among a diverse panel of global clinical experts. The panel was asked to iteratively rate proposed treatments and actions based on previous guidelines and the WHO Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent, user-friendly, and feasible EECC package of clinical processes plus a list of hospital resource requirements. Results The 272 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 hospital readiness requirements. The essential diagnosis-specific care of critically ill COVID-19 patients has an additional 7 clinical processes and 9 hospital readiness requirements. Conclusion The study has specified the content of the essential emergency and critical care that should be provided to all critically ill patients. Implementation of EECC could be an effective strategy to reduce preventable deaths worldwide. As critically ill patients have high mortality rates in all hospital settings, especially where trained staff or resources are limited, even small improvements would have a large impact on survival. EECC has a vital role in the effective scale-up of oxygen and other care for critically ill patients in the COVID-19 pandemic. Policy makers should prioritise EECC, increase its coverage in hospitals, and include EECC as a component of universal health coverage.

Use and Quality of Cesarean Delivery in a Low and Middle Income Setting: National Results from Two Emergency Obstetric and Newborn Care Assessments

Background: Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in CD rates and the capacity of the Ethiopian health system to deliver quality CD services, highlighting the role of the management sector.Methods: We compare results from two national cross-sectional emergency obstetric and newborn care assessments using descriptive statistics. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 CD case reviews in 2008 and 568 in 2016. Our primary outcome measures include population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management; and the relative size of Robson classification groupsResults: The national population-based rate increased (< 1% to 2.7%) as did all regional rates. Rates ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in the private for-profit sector in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and for-profit hospitals. Only half of the women whose cases were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9% to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, a third of case reviews from the public sector were among low-risk nulliparous women (Robson group 1).Conclusions: Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool.

Factors Affecting Hospital Readiness in Pandemic Situation: A Literature Review

Literature search was performed using Ebsco Host, Pubmed, ScienceDirect and Proquest databases with inclusion and exclusion criteria in accordance with the literature objectives. Review made on articles and obtained seven research articles that qualify reviews. The research article reviewed showed that there were several factors affecting the hospitals readiness in facing the pandemic. The factors are the availability of pandemic preparedness planning system, the availability of guidelines and infection prevention and control tools, education, training or simulation in facing the pandemic, the availability of facilities (medical devices and isolation room), communication system during the pandemic, the availability of human resources and pandemic preparedness evaluation system. An assessment of the factors affecting hospital readiness in facing the pandemic was performed to identify the challenges faced by hospitals and determine further action to improve hospital readiness in facing the pandemic that might occur in the future

“Virtual Interdisciplinary COVID-19 Team”: A Hospital Pandemic Preparedness Approach

The COVID-19 pandemic continues to move at record speed. Health systems and hospitals worldwide face unprecedented challenges to effectively prepare and respond to this extraordinary health crisis and anticipated surge. Hospitals should confront these unparalleled challenges with a comprehensive, multidisciplinary, coordinated, and organized strategy. We report our experience with the systematic application of the “4S” principle to guide our institutional preparedness plan for COVID-19. We used an innovative “virtual interdisciplinary COVID-19 team” approach to consolidate our hospital readiness.

Health services availability and readiness for COVID-19 case surge in hospitals of Nepal

Background As with other coronavirus-affected countries, Nepal’s medical community also expressed concerns regarding the government’s public health strategies and hospital readiness in response to increasing COVID-19 case surge. To gauge such response, we assessed service availability and readiness status in hospitals situated across seven provinces. Methods A web-based observational study was conducted between March 24 and April 07 in 110 hospitals, all of which were later designated as COVID-19 clinics or hospitals by Nepal Government. An electronic survey link was sent out to the clinicians working at the frontline in those hospitals. One response per hospital was analyzed. Hospitals were divided into small, medium, and large based on the total number of beds (small:15 or less; medium:16–50; large:>50), and further categorized into public, private, and mixed based on the ownership. Results Out of 110 hospitals, 81% (22/27) of small, 39% (11/28) of medium, and 33% (18/55) of large hospitals had not allocated isolation beds for COVID-19 suspects or cases. Majority of medium (89%; 25/28), and 38% of large hospitals did not have a functional intensive care unit (ICU) at the time of study. Nasopharyngeal (NP)/throat swab kits were available in one-third (35/110), whereas viral transport media (VTM), portable fridge box, and refrigerator were available in one-fifth (20%) of the hospitals. Only one hospital (large/tertiary) had a functional PCR machine. Except for General practitioners, other health cadres—crucial during pandemics, were low in number. On IPC measures, the supplies of simple face mask, gloves and hand sanitizers were adequate in the majority of hospitals, however, N95-respirators and PPE-suits were grossly lacking. Government’s COVID-19 support was unevenly distributed across provinces; health facilities in provinces 2, 4, and 5 received fewer resources than others. Conclusions Our findings alerted the Nepalese and other governments to act early and proactively during health emergencies and not wait until the disease disrupts their health systems. Other countries with similar economy levels may undertake similar surveys to measure and improve their pandemic response.