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Tools and Checklists Used for the Evaluation of Hospital Disaster Preparedness: A Systematic Review

Published online by Cambridge University Press:  27 May 2016

Mahmood Nekoie-Moghadam ,
Lisa Kurland ,
Mahmood Moosazadeh ,
Pier Luigi Ingrassia ,
Francesco Della Corte  and
Ahmadreza Djalali
Mahmood Nekoie-Moghadam
Affiliation:
Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Lisa Kurland
Affiliation:
Department of Clinical Sciences and Education, Karolinska Institutet, Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden
Mahmood Moosazadeh*
Affiliation:
Health Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
Pier Luigi Ingrassia
Affiliation:
Center for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, University degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy.
Francesco Della Corte
Affiliation:
Center for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, University degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy.
Ahmadreza Djalali
Affiliation:
Center for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, University degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy.
*
Correspondence and reprint requests to Mahmood Moosazadeh, Health Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, Iran (e-mail: mmoosazadeh1351@gmail.com).
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Abstract

Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words “crisis,” “disaster,” “disaster medicine,” “emergency,” “mass casualty,” “hospital preparedness,” “hospital readiness,” “hospital assessment,” “hospital evaluation,” “hospital appraisal,” “planning,” “checklist,” and “medical facility” were used in combination with the Boolean operators “OR” and “AND.” PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8)

Keywords

systematic reviewdisasterhospitalpreparedness
Type
Systematic Review
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 5 , October 2016 , pp. 781 - 788
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

Disaster is defined as a resource imbalance during an incident.Reference Kaji and Lewis 1 Hospitals need to uphold normal functions during a disaster.Reference Krajewski, Sztajnkrycer and Baez 2 However, studies of previous disasters have shown that hospitals located in disaster areas are not well prepared and usually become inoperative either as the result of direct damage or functional collapse.Reference Kaji and Lewis 1 - Reference Eitzen 3 Confusion over roles and responsibilities, poor communication, lack of planning, suboptimal training, and a lack of hospital integration into community disaster planning can lead to unprepared hospitals.Reference Kaji and Lewis 1 , Reference Manley, Furbee and Coben 4

Hospital preparedness is part of the disaster plan and should build on a standardized protocol. 5 - 9 Checklists and other evaluation tools should be incorporated into the hospital disaster plan in order to recognize possible gaps and weaknesses.Reference Djalali, Castren and Khankeh 10 Several hospital disaster preparedness evaluation methods have been created.Reference Kaji and Lewis 1 , Reference Krajewski, Sztajnkrycer and Baez 2 , 9 , Reference Djalali, Castren and Khankeh 10 However, no consensus exists on a standardized, comprehensive and reliable tool with which to measure hospital preparedness.Reference Djalali, Castren and Khankeh 10

The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. The results from the current study may serve as guidance for the development of a standardized evaluation tool as part of a comprehensive hospital disaster plan.

METHODS

The present study was a systematic review of publications and documents relating to evaluation tools for hospital disaster preparedness. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Reference Liberati, Altman and Tetzlaff 11

Search Strategy

The search was conducted during October 2013. Articles, checklists, and guidelines published between January 1, 1990, and October 10, 2013, were extracted. PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, New York, NY), and Google Scholar (Google Inc, Mountain View, CA) were searched. The search was restricted to English. The following key words and combinations thereof were used: “crisis,” “disaster,” “disaster medicine,” “emergency,” “mass casualty,” “hospital preparedness,” “hospital readiness,” “hospital assessment,” “hospital evaluation,” “hospital appraisal,” “planning,” “checklist,” and “medical facility.”

Selection of Articles and Documents

The selection of relevant publications was done independently by 2 of the authors (MNM, AD). The titles and abstracts of extracted articles and documents were screened to select relevant articles.

The selected publications were then read in full. The reference lists of the selected publications were also used to screen for additional relevant publications. Disparate opinions on relevance were solved through arbitration (MN). Duplicates were excluded.

Evaluation of Selected Publications

Inclusion Criteria

A publication or document that contained at least one of the hospital disaster preparedness elements, as listed below, in addition to obtaining a minimum of 8 “yes” of the 12 possible according to Table 1 were included in current study. These 12 questions reflected the study method, data collection tool, variable evaluation status, studied target group (hospitals), and key components of the publication and analysis status.

  • ∙ Logistic/supplies/facilities/resource

  • ∙ Planning and protocol

  • ∙ Human resources

  • ∙ Management of patient care and triage

  • ∙ Communication

  • ∙ Command and control

  • ∙ Structural and nonstructural resilience

  • ∙ Drill and training

  • ∙ Evacuation

  • ∙ Recovery after disaster

  • ∙ Coordination

  • ∙ Transportation

  • ∙ Surge capacity

  • ∙ Safety and security

Table 1 The Following Questions Were Assessed for Each of the Selected Articles and Documents Relevant to Evaluation Tools for Hospital Disaster Preparedness

Twelve questions that reflected the study method, data collection tool, variable evaluation status, studied target group (hospitals), key components of the publication, and analysis status (Table 1) were considered for each publication. Publications that obtained the minimum score of 8 were selected for further data extraction and analysis.Reference Moosazadeh, Nekoei-Moghadam and Emrani 12

Inclusion Criteria

An article or document that considered at least one of the hospital disaster preparedness elements, as listed above, in addition to obtaining a minimum of 8 “yes” of the 12 possible according to Table 1 were included in current study.

Exclusion Criteria

Publications lacking tools or checklists with which to evaluate hospital preparedness or for which the full text article was not available were excluded.

RESULTS

Database Search

A total of 51,809 documents were identified according to key words and screened for relevance in the first step. A total of 50,801 were removed in accordance with the inclusion criteria, leaving 1008 potentially relevant articles. Of these 1008 publications, 347 articles were excluded owing to the overlap of databases and redundancy. This left 661 publications to be considered.

Selection of Relevant Articles

The title and abstract of the 661 remaining publications were considered for relevance, and 525 articles were omitted for being irrelevant. An additional 70 articles were omitted after the full article was read, and 1 new article was added after review of the references. A total of 67 articlesReference Kaji and Lewis 1 , 9 - Reference Djalali, Castren and Khankeh 10 , Reference Aghababian, Lewis and Gans 13 - Reference Top, Gider and Tas 74 were relevant and were evaluated with respect to hospital preparedness elements and the checklist in Table 1.

Of the 67 evaluated articles, 52Reference Djalali, Castren and Khankeh 10 , Reference Aghababian, Lewis and Gans 13 - Reference Daneshmandi, Amiri and Vahedi 58 , Reference Vahedparast 60 , Reference Elazeem, Adam and Mehamed 61 , Reference Smith, Gorski and Vennelakanti 65 , Reference Richter 71 did not fulfill the stipulated inclusion criteria. Fifteen relevant articlesReference Kaji and Lewis 1 , 9 , Reference Mulyasari, Lnoue and Sunil 59 , Reference Toner, Waldhorn and Franco 62 - Reference Jl, Kelen and Souer 64 , Reference Calderon 66 - 70 , Reference Bremer 72 - Reference Top, Gider and Tas 74 fulfilled the criteria and are reviewed in the current study (Figure 1).

Figure 1 Review Selection Process and Results, in Accordance With the PRISMA Guidelines.Reference Liberati, Altman and Tetzlaff 11

Twelve of these 15 articles were published in 2008. The majority had been performed in the United States. One publicationReference Bremer 72 included an assessment tool with all 13 elements of hospital preparedness, whereas the other 14 articlesReference Kaji and Lewis 1 , 9 , Reference Mulyasari, Lnoue and Sunil 59 , Reference Toner, Waldhorn and Franco 62 - Reference Jl, Kelen and Souer 64 , Reference Calderon 66 - 70 , Reference Belmont, Fried and Gonen 73 , Reference Top, Gider and Tas 74 included between 4 and 12 of the stipulated elements (Table 2).

Table 2 Hospital Disaster Preparedness Evaluation Tools Fulfilling the Criteria of Relevance and Considering at Least One of the Predefined ThemesFootnote a

a Abbreviations: PAHO, Pan American Health Organization; WHO, World Health Organization.

The most common elements included in the articles were “procedures and protocols,” which were included in 13 articles. “Training and exercise” were included in 11 articles and “triage and medical care” were included in 9 articles (Table 2). The assessment tools reported in the current study considered various subthemes for each of the hospital disaster preparedness elements (Table 3).

Table 3 Elements and Subthemes of Hospital Disaster Preparedness From the 15 Included Articles

DISCUSSION

The results of the current systematic review of evaluation tools and checklists for hospital disaster preparedness screened an initial 51,809 articles. Fifteen publications fulfilled the criteria for relevance and considered at least 1 of the 14 predetermined themes: logistic/supplies/facilities/resource, planning and protocol, human resources, management of patient care and triage, communication, command and control, structural and nonstructural resilience, drill and training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety and security (Table 2). In addition, each theme included subthemes, which reflected a further detail of evaluation (Table 3). These results may be used to create an evaluation tool for the assessment of hospital disaster preparedness.

Hospitals are an important link in the chain of disaster response. It is essential to consider estimations of hazard risk for the specific hospital when planning for an effective medical disaster response.Reference Top, Gider and Tas 74 , Reference Tang, Fitzgerald, Hou and Wu 75 Surge capacity is one of the most important themes to consider with respect to hospital preparedness. The possibility to expand the capacity of hospitals and developing a community-wide response to natural or manmade incidents is crucial for mitigating effects on health care. The reviewed articles considered various aspects of surge capacity, eg, the elements of surge capacity, methods of increasing the surge capacity, and how to calculate the maximum capacity that can be surged.Reference Kaji and Lewis 1 , 9 , Reference Toner, Waldhorn and Franco 62

All phases of disaster management require protocols and plans, which was another predetermined theme for the evaluation tools, since all aspects of disaster management deal with the processes used to protect populations or property or from the effects of disasters.Reference Brevard 7 , Reference Djalali, Castren and Khankeh 10 The phases of the disaster management are mitigation, preparedness, delivery of medical support during the disaster, and recovery and support after any disaster.Reference Djalali, Castren and Khankeh 10 , Reference Smith, Gorski and Vennelakanti 65 In order to develop a comprehensive disaster plan, it is necessary that the responsibility to develop the plan be given to a committee or a subcommittee of the safety committee. The committee should include representatives from every department in the hospital. 9 This committee should include representatives from the medical staff (emergency room physician or trauma surgeon), administration (including risk manager) or management, nursing staff, emergency department, security, communications, public relations, medical records and admissions, engineering/maintenance, laboratory, radiology, and respiratory therapy.Reference Richter 71

Communication and coordination is the theme that involves activities that provide accurate and reliable information to and cooperation with the public, other organizations, and community institutions responding to the disaster. The information that appears to be needed focuses on health and safety, continuity of operations and government, critical facilities and infrastructure, delivery of services, the environment, and economic and financial conditions.Reference Tang, Fitzgerald, Hou and Wu 75

Health care personnel training in disaster preparedness is another theme of importance and affects maintenance and promotion of human resources. Training methods that can be used include maneuvers, practical drills, and facing actual events.Reference Tang, Fitzgerald, Hou and Wu 75

Hospital preparedness has previously been evaluated from different perspectives and has shown divergent results.Reference Daneshmandi, Amiri and Vahedi 58 , Reference Mulyasari, Lnoue and Sunil 59 , Reference Vahedparast 60 , Reference Elazeem, Adam and Mehamed 61 , Reference Calderon 66 , Reference Dormes, HamedBadi and Gromer 68 Dormes et alReference Dormes, HamedBadi and Gromer 68 showed that human resource is the highest level of hospital preparedness and the lowest rank is for training activities. Daneshmandi et alReference Daneshmandi, Amiri and Vahedi 58 studied hospitals in Iran and reported that the level of preparedness depends on training, logistics, and management units, whereas safety, evacuation and transport, staffing, communication, and traffic were at a weak level of preparedness.

In a comprehensive study including 45 hospitals in the United States, 43 of 45 (96%) had hospital disaster plans based on the hospital Incident Command System and all had protocols for hospitals (100%). All hospitals had emergency medical services-compatible radios and more than 3 days’ worth of food supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted mitigating drills, only 16% actually involved other agencies in their disaster training. Only 13 of the 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had 10 or more isolation rooms and 27 hospitals (66%) were on diversion for greater than 20% of them. Less than half had contamination (42%), whereas approximately one-half (51%) had antibiotics and 42% had stockpiles.Reference Kaji and Lewis 1

Disaster preparedness consists of a wide range of measures, with both long- and short-term effects, designed to save lives and limit the damage that may otherwise be caused by the incident. Preparedness is concerned with policies and programs to minimize the impact of disasters. Corresponding measures are taken in fields other than medical, eg, legislative, physical and urban planning, public works. Short-term preparedness measures can be taken during a warning period before the impact of an incident and need to be supported by legislation and should include operational planning, education and training of the population at large, and the technical training, stockpiling, and emergency funding arrangements. Preparedness measures also need to include vulnerability analyses and warning systems in addition to evacuation plans. The more effectively these measures are carried out in advance, the more readily it will be possible to take the action necessary during the emergency phase itself and in the later phases of mitigation, rehabilitation, and reconstruction. 9 Hence, the evaluation of hospital preparedness needs to be performed.

The present systematic review showed that none of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of this systematic review could be used to prepare a standardized tool to evaluate hospital disaster preparedness.

CONCLUSION

The results of the current systematic review of evaluation tools and checklists for hospital disaster preparedness screened 51,809 articles. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of this systematic review could be used to prepare a standardized tool to evaluate hospital disaster preparedness.

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Figure 0

Table 1 The Following Questions Were Assessed for Each of the Selected Articles and Documents Relevant to Evaluation Tools for Hospital Disaster Preparedness

Figure 1

Figure 1 Review Selection Process and Results, in Accordance With the PRISMA Guidelines.11

Figure 2

Table 2 Hospital Disaster Preparedness Evaluation Tools Fulfilling the Criteria of Relevance and Considering at Least One of the Predefined Themesa

Figure 3

Table 3 Elements and Subthemes of Hospital Disaster Preparedness From the 15 Included Articles