Assessing Hospital Disaster Preparedness: A Comparison of an On-Site Survey, Directly Observed Drill Performance, and Video Analysis of Teamwork

Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
Annals of emergency medicine (Impact Factor: 4.68). 02/2008; 52(3):195-201, 201.e1-12. DOI: 10.1016/j.annemergmed.2007.10.026
Source: PubMed


There is currently no validated method for assessing hospital disaster preparedness. We determine the degree of correlation between the results of 3 methods for assessing hospital disaster preparedness: administration of an on-site survey, drill observation using a structured evaluation tool, and video analysis of team performance in the hospital incident command center.
This was a prospective, observational study conducted during a regional disaster drill, comparing the results from an on-site survey, a structured disaster drill evaluation tool, and a video analysis of teamwork, performed at 6 911-receiving hospitals in Los Angeles County, CA. The on-site survey was conducted separately from the drill and assessed hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity, decontamination capability, and pharmaceutical stockpiles. The drill evaluation tool, developed by Johns Hopkins University under contract from the Agency for Healthcare Research and Quality, was used to assess various aspects of drill performance, such as the availability of the hospital disaster plan, the geographic configuration of the incident command center, whether drill participants were identifiable, whether the noise level interfered with effective communication, and how often key information (eg, number of available staffed floor, intensive care, and isolation beds; number of arriving victims; expected triage level of victims; number of potential discharges) was received by the incident command center. Teamwork behaviors in the incident command center were quantitatively assessed, using the MedTeams analysis of the video recordings obtained during the disaster drill. Spearman rank correlations of the results between pair-wise groupings of the 3 assessment methods were calculated.
The 3 evaluation methods demonstrated qualitatively different results with respect to each hospital's level of disaster preparedness. The Spearman rank correlation coefficient between the results of the on-site survey and the video analysis of teamwork was -0.34; between the results of the on-site survey and the structured drill evaluation tool, 0.15; and between the results of the video analysis and the drill evaluation tool, 0.82.
The disparate results obtained from the 3 methods suggest that each measures distinct aspects of disaster preparedness, and perhaps no single method adequately characterizes overall hospital preparedness.

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    • "For example, in the review of responses to disaster preparedness by Chaffe et al., 90 % of the 27 studies reviewed were derived from statewide and countywide populations with only a minority from single institutions [2,3]. Kaji and colleagues in 2008 suggested that a multi-pronged approach targeted at individual health care workers and hospitals would be needed to adequately characterize overall institution preparedness [4]. "
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    ABSTRACT: There is limited research on preparation of health care workers for disasters. Prior research addressed systems-level responses rather than specific institutional and individual responses. An anonymous online survey of hospital employees, who were grouped into clinical and non-clinical staff, was conducted. The objective of this study was to compare perceptions of clinical and non-clinical staff with regard to personal needs, willingness to report (WTR) to work, and level of confidence in the hospital's ability to protect safety and provide personal protective equipment (PPE) in the event of a disaster. A total of 5,790 employees were surveyed; 41 % responded (77 % were women and 63 % were clinical staff). Seventy-nine percent either strongly or somewhat agreed that they know what to do in the event of a disaster, and the majority was willing to report for duty in the event of a disaster. The most common barriers included 'caring for children' (55 %) and 'caring for pets' (34 %). Clinical staff was significantly more likely than non-clinical staff to endorse childcare responsibilities (58.9 % vs. 48 %) and caring for pets (36 % vs. 30 %, respectively) as barriers to WTR. Older age was a significant facilitator of WTR [odds ratio (OR) 1.49, 95 % CI: 1.27-1.65]. Non-clinical staff was more confident in the hospital's ability to protect safety and provide PPE compared to clinical staff (OR 1.43, 95 % CI: 1.15-1.78). Clinical and non-clinical staff differ in the types of barriers to WTR endorsed, as well as their confidence in the hospital's ability to provide them with PPE and guarantee their safety.
    Full-text · Article · Jun 2012 · International Journal of Emergency Medicine
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    • "Previous studies evaluating hospital management during simulated disasters demonstrated a similar level of performance [23,39-41]. However, these studies [23,39-41] have only evaluated decision making with respect to the command and control functions, and not the overall organisation. It is necessary to evaluate all components of the hospital disaster response in order to assess the efficacy of the hospital response to a disaster. "
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    ABSTRACT: Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises. This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used. None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04). The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.
    Full-text · Article · Feb 2012 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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    • "However, it is expensive and not reported widely to other countries except of Asia. Realistic disaster drills proved to be the most effective technique for enhancing preparedness in Korea because actual hospital disasters rarely occur.27-29 "
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    ABSTRACT: The purpose of this study is to systematically review and analyze disasters involving South Korean hospitals from 1990 and to introduce a newly developed implement to manage patients' evacuation. We searched for studies reporting disaster preparedness and hospital injuries in South Korean hospitals from 1990 to 2008, by using the Korean Studies Information Service System (KISS, copyright Korean Studies Information Co, Ltd, Seoul, Korea) and, simultaneously, hospital injuries which were reported and regarded as a disaster. Then, each study and injury were analyzed. Five studies (3 on prevention and structure, 1 on implement of new device, and 1 on basic supplement to current methods) and 8 injuries were found within this period. During the evacuations, the mean gait speed of walking patients was 0.82 m/s and the mean time of evacuation of individual patients was 38.39 seconds. Regarding structure evaluation, almost all hospitals had no balconies in patient rooms; hospital elevators were placed peripherally and were insufficient in number. As a new device, Savingsun (evacuation elevator) was introduced and had some merits as a fast and easy tool, regardless of patient status or the height of hospital. In South Korea, preparation for hospital disasters was noted to be insufficient but has involved various departments such as architectural, clinical, and building operations. In addition, Savignsun has been shown to effectively evacuate and save patients in a hospital disaster.
    Full-text · Article · Nov 2010 · Yonsei medical journal
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