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Organization Chart for Regionalization
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Successful management of an event where healthcare needs exceed regional healthcare capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams manage the allocation of scarce resources during COVID-19 are lacking. Over a period of 3 weeks,...
Citations
... Since the beginning of COVID-19, several researches have studied clinical features, diagnosis, treatment, and clinical and economic consequences of the disease mostly (9,10,(23)(24)(25). Some have also studied preparedness, response, incidence commanding system, and allocated resources (26)(27)(28)(29)(30)(31). ...
Objective:Pandemics have been considered among the main hazards of two last decades around the world. Hospitals are one of the most important organizations responding to pandemics. Aim of this study was to design and develop a valid checklist for evaluating the hospitals’ performance in response to COVID-19 pandemic, for the first time.
Methods:This study is a mixed method research design that began in 2020 February and was conducted in three phases: Designing a conceptual model, designing a primary checklist structure, and checklist psychometric evaluation. Known groups method has been used to evaluate construct validity. Therefore, two groups of hospital were compared; (group A: COVID-19 Hospitals, and group B: the other Hospitals).
Results:The main structure of checklist was designed with 6 main domains, 23 sub-domains, and 152 items. The content validity ratio and index were 0.94 and 0.79 respectively. Eleven items were added, 106 items were removed, and 40 items were edited. Independent t-test showed a significant difference between scores of two groups of hospitals (P<0.0001). Pearson correlation coefficient test also showed a high correlation between our checklist and the other. The internal consistency of the checklist was 0.98 according to Cronbach’s alpha test.
Conclusions:By evaluating the hospitals’ performance and identifying their strengths and weaknesses, can help health system policymakers and hospital managers, and leads to improved performance in response to COVID-19.
... Although the CHEST Implementation Guide (a guideline for implementing regional triage) underlines the importance of consistent application within regions, 18 participants identified lower levels of preparedness at smaller hospitals, as mentioned previously. 14 In keeping with past studies, 17,19 several participants discussed the importance of end-to-end simulations. ...
Background:
As the COVID-19 pandemic created a surge in demand for critical care resources, the province of Ontario, Canada, released the Adult Critical Care Clinical Emergency Standard of Care for Major Surge (Emergency Standard of Care [ESoC]), a triage framework to guide the allocation of critical care resources in the expectation that intensive care units would be overwhelmed. Our aim was to understand physicians' and administrators' experiences and perceptions of planning to implement the ESoC, and to identify ways to improve critical care triage processes for future pandemics.
Methods:
We conducted semistructured qualitative interviews with critical care, emergency and internal medicine physicians, and hospital administrators from various Ontario health regions who were involved in their hospital's or region's ESoC implementation planning. Interviews were conducted virtually between April and October 2021. We analyzed the data using thematic analysis.
Results:
We conducted interviews with 11 physicians and 10 hospital administrators representing 9 health regions. We identified 4 themes regarding participants' preparation to implement the ESoC: infrastructure to enable effective triage implementation; social, medical and political supports to enable effective triage implementation; moral dimensions of triage implementation; and communication of triage results. Participants outlined administrative and implementation-related improvements that could be provided at the provincial level, such as billing codes for ESoC. They also suggested improving ethical supports for the usability and quality of the ESoC (e.g., designating an ethicist in each region), and ways to improve the efficiency and usability of the tools for assessing short-term mortality risk (e.g., create information technology solutions such as a dashboard).
Interpretation:
The implementation of a jurisdiction-level triage framework poses moral challenges for a health care system, but it also requires dedicated infrastructure, as well as institutional supports. Lessons learned from Ontario's process to prepare for ESoC implementation, as well as participants' suggestions, can be used for planning for current and future pandemics.
... 9 These concerns were again reinforced by the impact of Hurricane Sandy on the New York City healthcare system in 2012 10 and the severe limitation of hospital capacity identified during surges in the COVID-19 pandemic. [11][12][13] In December 2019, Congress recognized the need to strengthen NDMS's definitive care component and directed the Secretary of Defense to conduct an NDMS pilot program to increase the nation's medical surge capability, capacity, and interoperability. 14 Given the DOD's leading role in the pilot and the NDMS's original purpose of preparing for casualties from a conventional military conflict in Europe, 1-3 the scenario chosen to drive assessments and interventions for the pilot was an overseas conflict leading to 1,000 injured soldiers daily for 100 days. ...
... The focus of many of the opportunities recommended from the qualitative and quantitative MCNIS research and much of the NDMS literature for almost the last 20 years has been to increase the healthcare coordination capacities at the regional, not federal, level. 5,9,12,13,24,[29][30][31][32][33] ASPR coordinates numerous healthcare preparedness and response programs that focus on regional preparedness and response, including the NDMS, 4 Hospital Preparedness Program, 34 Regional Emergency Coordinators, 35 and Regional Treatment Network for Ebola and Other Special Pathogens. 36 The Hospital Preparedness Program is the primary source of federal support for healthcare system preparedness and response. ...
The National Disaster Medical System (NDMS) Pilot Program was authorized by Congress to improve the interoperability, capabilities, and capacity of the NDMS. To develop a roadmap for planning and research, the mixed-methods Military-Civilian NDMS Interoperability Study (MCNIS) was conducted in 2020-2021. The initial qualitative phase of the study identified critical themes for improvement: (1) coordination, collaboration, and communication; (2) funding and incentives to increase private sector preparedness; (3) staffing capacity and competencies; (4) clinical and support surge capacity; (5) training, education, and exercises between federal and private sector partners; and (6) metrics, benchmarks, and modeling to track NDMS performance. These qualitative findings were subsequently refined, validated, and prioritized through a quantitative survey. Expert respondents ranked 64 statements based on weaknesses and opportunities identified during the qualitative phase. Data were collected using Likert scales, and multivariate proportions and confidence intervals were estimated to compare and prioritize each statement's level of support. Pairwise tests were conducted for each item-to-item pair to determine statistically significant differences. The survey results corroborated the earlier qualitative findings, with all weaknesses and opportunities ranked as important by a majority of respondents. Survey results also pointed to specific priorities for interventions within the 6 previously identified themes. As with the qualitative study, the survey found that the most common weaknesses and opportunities were related to coordination, collaboration, and communication, especially regarding information technology and planning at the federal and regional levels. These priority interventions are now being developed, implemented, and validated at 5 pilot partner sites.
... 17,33 Successful health care coalition activities during previous disasters have included information sharing, coordinating nursing home evacuations, load balancing resident transfers across multiple nursing homes, ensuring continuity of dialysis services for affected residents, and sharing of scarce resources among member institutions. [34][35][36][37][38] A recent report from the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response 37,38 described multiple ways in which health care coalitions have benefited their members during the COVID-19 pandemic, highlighting key roles that health care coalitions can continue to play during future disasters. Such benefits included supporting members with fewer resources, leveraging the coalition's size to acquire and distribute resources, and most importantly sharing quantitative and qualitative data, such as bed availability and surge capacity management strategies, between nursing homes to enhance members' situational awareness and to facilitate informed decisionmaking around individual nursing home responses to the pandemic. ...
... For example, implementation strategies such as network weaving, coalition building, and resource sharing agreements can promote more sustainable nursing home engagement at all levels of emergency management. 33,43 As noted previously, these relationships, ideally established as part of the planning process, can facilitate information transfer during a disaster, [34][35][36][37][38] particularly when guidelines and information from multiple sources may be contradictory or conflicting. They can also promote distribution and sharing of key resources used during activation of a nursing home's emergency plan, [34][35][36][37][38] such as personal protective equipment, which was often difficult for nursing homes to obtain during the early stages of the COVID-19 pandemic. ...
... 33,43 As noted previously, these relationships, ideally established as part of the planning process, can facilitate information transfer during a disaster, [34][35][36][37][38] particularly when guidelines and information from multiple sources may be contradictory or conflicting. They can also promote distribution and sharing of key resources used during activation of a nursing home's emergency plan, [34][35][36][37][38] such as personal protective equipment, which was often difficult for nursing homes to obtain during the early stages of the COVID-19 pandemic. 17 ...
As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for health care readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as health care readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. We describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance health care readiness in the nursing home setting and illustrate how implementation science can better support health care readiness planning for nursing homes. We rest on 3 main themes: (1) implementation science frameworks can strengthen nursing home staff engagement around health care readiness; (2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes' unique needs; and (3) implementation science can advance the integration of nursing homes into local, state, and federal health care readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.
... Alkhawlani, Bohari, and Shamsuddin (2019) emphasize the critical role of transformational leadership in navigating organizational crises, particularly in volatile regions like Yemen, where political and resource-based uncertainties prevail (Alkhawlani et al., 2019). Similarly, leadership competencies in crisis situations have been extensively studied across various contexts, including healthcare emergencies and disaster preparedness (Knebel et al., 2014;Yang et al., 2020). These studies highlight the necessity for leaders to adapt quickly, make decisive actions, and maintain organizational integrity amidst turmoil. ...
... This study's findings underscore the role of leaders in influencing team dynamics and managing change, which are crucial for adapting organizational practices in response to crises. This observation is supported by Yang et al. (2020), who detailed the formation of a regional healthcare coalition in San Diego County as a response to COVID-19, illustrating how leadership can effectively mobilize and manage resources in a coordinated effort across various organizations. ...
Crises pose significant challenges for leaders, particularly in the management of scarce resources. The objective of this study was to explore the decision-making processes of leaders across various sectors during crisis situations, focusing on how they navigate the complexities of strategic decision-making, leadership challenges, and organizational dynamics. This qualitative study employed semi-structured interviews with 20 leaders experienced in crisis management from sectors including healthcare, emergency services, business, and non-profit organizations. Data collection aimed at achieving theoretical saturation was guided by a set of pre-determined, open-ended questions allowing for in-depth exploration of individual experiences and strategies. The interviews were transcribed, coded, and analyzed to identify recurring themes and patterns. Three main themes were identified: Strategic Decision-Making, Leadership Challenges, and Organizational Dynamics. Strategic Decision-Making encompassed risk assessment, resource allocation, long-term planning, stakeholder engagement, and decision-making styles. Leadership Challenges included communication barriers, ethical dilemmas, and stress and pressure management. Organizational Dynamics covered team dynamics, change management, leadership influence, resource management, and policy and governance. Each theme and its categories highlighted specific strategies and challenges faced by leaders in managing scarce resources effectively during crises. The study highlights the critical importance of strategic decision-making, robust communication, ethical leadership, and adaptive organizational policies in crisis management. Leaders who effectively navigate these aspects are better equipped to handle crises, suggesting a need for targeted training and policy development to enhance crisis preparedness and leadership competencies.
... In addition, many patients opted to willfully delay treatment for the fear of COVID-19 contraction during hospital encounters [7]. Many healthcare providers have also experienced unforeseen challenges such as working in fields beyond their expertise, managing cases with scarce resources, overcoming ethical issues, and risking their own lives to COVID-19 [8][9][10][11]. ...
Purpose:
To assess the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database.
Methods:
We conducted a retrospective analysis of the California State Inpatient Database (SID) 2019 and 2020. All adult (18 years or older) hospitalizations were included for the analysis. The primary outcomes were trends in hospitalization for intracranial meningioma resection between 2019 and 2020. Secondary outcomes were Clavien-Dindo grade IV complications, in-hospital mortality, and prolonged length of stay, which was defined as length of stay ≥75 percentile.
Results:
There were 3,173,333 and 2,866,161 hospitalizations in 2019 and 2020, respectively (relative decrease, 9.7%), of which 921 and 788 underwent intracranial meningioma resection (relative decrease, 14.4%). In 2020, there were 94,114 admissions for COVID-19 treatment. Logistic regression analysis showed that year in which intracranial meningioma resection was performed did not show significant association with Clavien-Dindo grade IV complications and in-hospital mortality (OR, 1.23, 95% CI: 0.78-1.94) and prolonged length of stay (OR, 1.05, 95% CI: 0.84-1.32).
Conclusion:
Our findings show that neurosurgery practice in the US successfully adapted to the unforeseen challenges posed by COVD-19 and ensured the best quality of care to the patients.
... Rambhia et al. [43] conduct a survey to reveal the status of the U.S. hospitals joining healthcare coalitions for emergency preparedness and response and to develop guidance for healthcare coalition development and emergency response. Devereaux et al. [44] present a framework for building healthcare coalitions, developing crisis care standards and providing triage team training. To the best of our knowledge, there is a paucity of literature, which conducts quantitative analyses on pre-and post-disaster emergency supply management in regional healthcare coalitions. ...
A regional healthcare coalition enables its member hospitals to conduct an integrated emergency supply management, which is seldom addressed in the existing literature. In this work, we propose a two-stage stochastic emergency supply planning model to facilitate cooperation and coordination in a regional healthcare coalition. Our model integrates pre-disaster emergency supplies pre-positioning and post-disaster emergency supplies transshipment and procurement and considers two planning goals, i.e., minimizing the expected total cost and the maximum supply shortage rate. With some comparison models and a case study on the West China Hospital coalition of Sichuan Province, China, under the background of the COVID-19 epidemic, we demonstrate the effectiveness and benefits of our model and obtain various managerial insights and policy suggestions for practice. We highlight the importance of conducting integrated management of emergency supplies pre-positioning, transshipment and procurement in the regional healthcare coalition for better preparation and responding to future potential disasters.
... For example, in the United Kingdom (UK), the command-and-control mechanism of its public healthcare system was employed to mobilize existing resources (e.g., reorganizing healthcare provisions by minimizing routine services); meanwhile, the National Health Service contacted private hospitals to secure block-bought hospital beds, thus increasing the overall capacity to treat COVID-19 patients (1). In the United States (US), various partnerships among public agencies and private-dominant healthcare providers have efficiently functioned to handle similar issues (2,3). ...
The coronavirus disease 2019 (COVID-19) pandemic has exposed various weaknesses in national healthcare systems across the globe. In Japan, this includes the inability to promptly mobilize the resources needed to provide inpatient care in response to the rapidly increasing number of patients. Combined with unclear entry points to healthcare, particularly in emergency cases, this has led to a situation in which access to healthcare is rapidly deteriorating. This study examined problems in Japan's healthcare delivery system. While Japan's healthcare resources (e.g., hospital beds and medical personnel) are comparable to those found in other high-income countries, progress has been slow in securing beds for COVID-19 patients. In addition, the number of beds has only recently reached the levels seen in Western countries. Factors related to slow resource allocation include dispersed existing medical resources (mainly in the private sector), the lack of collaboration mechanisms among private-dominant healthcare providers and public health agencies, an inadequate legal framework for resource mobilization, the insufficient quantification of existing resources, and undesignated entry points to healthcare systems. To better prepare for future disasters, including the next wave of COVID-19, Japan urgently needs to restructure its legal framework to promptly mobilize resources, accurately quantify existing resources, introduce coordination mechanisms with functional differentiations among all community stakeholders, and clearly designate entry points to healthcare.
... Along with available guidelines, the HCS must ensure that the available resources are wisely allocated to patients requiring critical care. The HCI and public health administration can implement coping strategies for improving the supply, rational use, appropriate sharing, and allocation of healthcare resources (Devereaux et al., 2020;Sharma et al., 2020). ...
... It is imperative to utilize, wisely allocate, and conserve resources during the COVID-19 pandemic. The information about the required quantity, rate of use of these resources, and contingency planning during stock shortage will help to have adequate stockpiling in pandemic situations Rowan & Laffey, 2020;Yang et al., 2020;Ehrlich et al., 2020;Ojha et al., 2020;Alhalaseh et al., 2020;Sharma et al., 2020;WHO, 2020c;CDC, 2020a;CDC, 2020b;Devereaux et al., 2020 LC8 High-quality personal protective equipment (PPEs) ...
The prosed study aims to provide COVID‐19 critical success factors (CSF) associated with pandemic circumstances in the Indian healthcare industry (HCI). The CSF was identified via expert team inputs and a detailed literature review. The Decision‐Making Trial and Evaluation Laboratory (DEMATEL) method is used to determine the causal relationship between identified CSF. The methodology was supported by the case study of the Indian HCI. A total of 15 CSF in the Indian HCI during COVID‐19 are identified and prioritized using the DEMATEL method. The findings indicate that the high‐quality personal protective equipment (PPEs; LC8) and testing laboratories/facilities, centres, and kits (LC15) are the significant cause, and appropriate healthcare laws (LC13) are the least effect group. The study shows that policy and decision‐makers need to emphasize on LC8 and LC15 CSF in the Indian HCI and act accordingly to win the battle against post‐COVID‐19 circumstance. The policy/decision‐makers and healthcare administrations can identify the CSF and focus on that particular CSF. The identified CSF will help policy and decision‐makers swiftly build up the HCI to cope with the future pandemic.
... In the setting of a pandemic, allocation of scarce resources such as ECMO must shift from prioritization of the good of the individual to the good of the community when crisis standard of care is declared. 1,8 The ethical guiding principles in this setting include the prioritization of the most lives saved, equity, transparency, and duty to plan. Establishing crisis standards in advance, will contribute to maximizing the number of lives saved. ...
... The establishment of the Southern California ECMO consortium allowed for: (1) equitable provision of ECMO to patients in our region; (2) ninety-seven patients received ECMO from three California counties (San Diego, Imperial, and Riverside) and a neighboring state The consortium's initial goal was to provide ECMO fairly to patients in San Diego and Imperial Counties. However, during the pandemic our consortium of ECMO centers received referrals from outside counties and states. ...
In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the four ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO utilization would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.
