Introduction
Recently, the number of public health emergencies has increased worldwide. Major emergencies include disasters caused by environmental degradation, spreading of emerging or re-emerging infectious diseases, anthropogenic chemical, biological, or nuclear pollution, and conflicts due to social problems, economic imbalance, and cultural tribalism.Reference Arnold1–Reference Xue, Zhang and Zhong3 Hospitals must respond to these events, either directly or indirectly. Therefore, hospital emergency management must be improved.Reference Xin4,5 This was a pilot study intended: (1) to assess the status of hospital emergency management in the Beijing area; (2) make recommendations to government health authorities and hospital managers based on the analysis; and (3) offer references for similar studies.
Methods
This study assessed and analyzed hospital emergency management in the Beijing area. It was an observational, cross-sectional survey.
From 28 November 2008 to 23 February 2009, 45 of 68 hospitals in the Beijing area were selected randomly to participate in the survey. Chinese hospitals are divided into three levels: first-level hospitals are community hospitals, second-level hospitals are borough or county hospitals or hospitals that service multiple communities, and third-level hospitals are city hospitals or hospitals that service multiple regions.6 In the Beijing area, there are 50 third-level hospitals, 92 second-level hospitals, and 320 first-level hospitals.7 The 50 third-level hospitals and 18 borough hospitals among the second-level hospitals comprise the main force for emergency response in the Beijing area.8 These 68 hospitals are the focus of this study.
The data collection tool, a self-administered questionnaire, was mailed, at random, to 45 hospital administration departments. Administrative staff members were chosen as respondents because this department is the focal point for emergency preparedness and response. Its staff members are responsible for planning and executing emergency preparedness plans, and are in charge of the coordination of emergency response action.
The questionnaire consisted of three sections:
Section A was an introduction, and stated study objectives
Section B reviewed institutional and respondent demographics, including emergency response experience; and
Section C comprised the major part of the questionnaire, and was intended to obtain information regarding the hospital's general emergency management situation.9–11 It included whether the hospital had the following aspects:
a. Developed a hospital emergency management program and adopted a systems-based approach to management;
b. Ensured that the emergency management program met its objectives by establishing institutional arrangement;
c. Established a hospital Emergency Management Committee to oversee and guide the activities of the emergency management program;
d. Conducted a hazard-vulnerability analysis and used the results as the base of hospital emergency management;Reference Xin12–Reference Arnold13
e. Developed comprehensive and hazard-specific plans, conducted training and exercises, and evaluated the hospital's emergency management for continuing improvement;14,Reference Adini, Goldberg, Laor, Cohen, Zadok and Bar-Dayan15
f. Prepared for major public health emergencies;
g. Established an integrated hospital incident command system;16–18
h. Coordinated with outside resources for continuity of operation and medical surge; and
i. Made suggestions to hospital emergency management.
Data processing was conducted using Microsoft Excel 2003 [Microsoft Inc., Redmond, WA], and answers acquired from open questions were summarized.
Results
By 10 April 2009, 20 questionnaires were returned. The survey response rate was 44%. When the other 25 hospitals were asked why they not participate in the survey, five (20%) hospitals answered that they have no time, three (12%) hospitals doubted the aim of the survey, and 17 (68%) did not want to explain.
All respondents reported that they have experiences in public health emergencies, and 19 (95%) claimed that hospital emergency management currently is one of their responsibilities.
The major public health emergencies to which hospitals responded in the past five years included: disasters, infectious diseases, mass casualties, failure of key functional systems, food-medicine-chemistry safety incidents, and mass gatherings (Olympic Games).
Hospital Emergency Management Program and Systems-Based Management
A total of 55–90% of hospitals have a hospital emergency management program. They also have defined mid- and long-term goals, the emergency responsibilities of departments and collaborative agreements, and the responsibilities of personnel. They implemented an annual plan that they evaluate regularly.
Ensure Emergency Management Program Meet its Objectives
Of the responding hospitals, 40% had emergency management budgets; 55% hospitals assigned a leader to be in charge of emergency management. No hospital had established an emergency management department, but 35% of hospitals assigned a department to coordinate response actions. Others distributed the responsibilities to different departments. No hospitals have full-time emergency management personnel.
Hospital Emergency Management Committee
Although most of respondents thought it was necessary to establish a hospital Emergency Management Committee, only 35% of hospitals had established the Committee. Of these, 43% (15% of the total) conducted regular activities; 57% (20% of the total) were considered to play the leading role in emergency management.
Hazard Vulnerability Analysis
Thirty-five percent of the respondents did not know about vulnerability analysis, and 60% of them had a –general idea”. Only 15% of hospitals had performed a vulnerability analysis. The others used the government health authority's requirements and previous experiences as the basis to develop emergency plan and conduct training and practice.
Comprehensive and Hazard-Specific Plans, Training and Exercises, and Evaluation
Most of the responding hospitals reported that they have a comprehensive plan and a hazard-specific plan, and conducted training and exercises based on the plan. Some hospitals arranged a budget for these activities. Forty-five percent of hospitals regularly evaluated emergency management for continuing improvement.
Preparation for Major Public Health Emergencies
Most hospitals had equipment, medications, supplies, vaccines, and proper storage, and evaluated the plan regularly.
Establish an Integrated Hospital Incident Command System
Most hospitals have their own incident command system. Usually, the head of the hospital is the commander, and each managing department coordinates according to their assigned responsibilities. Only 10% of hospitals prescribed emergency response terminology; 45% hospitals regulated information collection, reporting, and announcement standard operating procedures (SOPs); 25% of respondents thought that the local government health authority had developed an integrated hospital emergency command system, and had promoted it among the hospitals.
Coordination with Outside Resources
Fifty-five percent of hospitals contracted with manufacturers to prioritize supplemental supplies during emergencies; 50% of hospitals contracted with public departments to provide backup for key functional systems. Forty percent of hospitals contracted with other hospitals or medical institutions to offer professional support when necessary. Of the others, 50% (30% of the total) of hospitals hoped that the government health authority would coordinate support, 33% (20% of the total) would ask for support themselves, 17% (10% of the total) did not answer.
Suggestions to Hospital Emergency Management
Suggestions included establishing an integrated, standardized, and scientific hospital emergency management model (45%); enhancing of emergency response training (20%); maintaining and implementing various emergency plans (10%); enhancing coordination between hospitals (10%); regular emergency response practice (5%); having a functional hospital emergency management committee (5%); budgeting for emergency management (5%); and regular evaluations of emergency management (5%).
Discussion
Although Chinese hospital managers recently have been paying more attention to hospital emergency management, studies on the status of hospital emergency management are not sufficient.Reference Jin19
The data collection tool used in this study involves all major aspects of hospital emergency management; all respondents were from administrative departments, as they have first-hand knowledge of the hospital and public health emergency response. Most of the respondents (95%) currently assume the responsibilities of hospital emergency management. The results of this assessment provide some guidance, and recommendations could be made to government health authorities. These results also will be useful references for similar studies.
Compared with other regions and other countries, the major public health emergencies experienced in the Beijing area are not different, but Beijing's status as the capital city of China make its hospital emergency responses unique, such as responses to mass gatherings (e.g., the Olympics) .
Based on the data, hospital managers in the Beijing area should attach more importance to institutional arrangements. Usually, some forms of institutional arrangements are guarantees for the development and of a maintenance emergency management program. The arrangements could include strong leadership, adequate budget, a special department and personnel or unambiguous focal point for coordination, etc.11 Of the hospitals that participated in the assessment, no hospital reported having a special department and a full-time staff for emergency management; and the budget, leadership, and coordination levels are relatively low. Without the proper institutional commitments, it is difficult to meet the objectives of an emergency management program.
Like other hospital committees, the Emergency Management Committee plays a key role in developing an emergency management program and steering emergency management activities.9 Hospital managers in the Beijing area should have a higher regard for the hospital Emergency Management Committee's role as a overseer and guider. Although awareness of the Committee's importance was high, only a few hospitals actually had established and conducted regularly emergency management activities. More effort is required to form and maintain an Emergency Management Committee.
Emergency management research and practice indicate that hazard vulnerability analysis is a useful method for profiling the emergencies to which a hospital is susceptible, to target specific problems of hospital emergency management, and to justify planning, training, and drills.Reference Xin12 In this study, only 15% of hospitals had performed a vulnerability analysis. Hospital managers in the Beijing area should be aware of the importance of hazard-vulnerability analysis, and to use it to improve hospital emergency management.
The results of this study also suggest other issues hospital mangers in the Beijing area must address. They include: (1) regular emergency management evaluations and improvements; (2) defined emergency response terminology, information collection regulations, reporting, and standard operating procedures; and (3) improved coordination with outside resources for continuity of operation and medical surge.
The low response rate (44%) is a limitation of this assessment. Although the aim of the assessment was outlined at the beginning of the questionnaire, and it was noted that the data would be used for scientific study only and personal information would be kept confidential, some hospitals (12%) still worried that the assessment would damage reputation of their institution. Testing showed that the questionnaire could be finished in 15 to 20 minutes, but some hospitals (20%) claimed that they did not have time to finish it. Therefore, a low response rate may be a problem for similar studies.
Based on the respondents' suggestions and experiences,Reference Xin20,Reference Xin21 it is recommended that a government health authority:
1. Establishes an integrated, standardized, operational hospital emergency management model;
2. Makes institutional arrangements to ensure hospital emergency management;
3. Exert the Hospital Emergency Management committee to oversee and guide the hospital emergency management program;
4. Conducts a hazard-vulnerability analysis to identify the major public health emergencies and use the results as the basis for planning, training, and drills;
5. Establishes an integrated hospital incident command system to ensure the coordination of response action; and
6. Conducts regular evaluations for continuing improvement of hospital emergency management.
Conclusions
Hospital emergency management is a relatively new concept for Chinese hospital managers. The 2003 severe acute respiratory syndrome (SARS) epidemic brought its importance to light, and many measures have been taken to improve hospital resilience. However, most of these efforts are based mainly on past emergency response experiences. They lack the guidance of theories, concepts, principles, and methods. Many initiatives focus almost exclusively on drafting an emergency response plan, identifying and establishing specific standby resource capacities.Reference Li22 An integrated, standardized, operational hospital emergency management model has not been established. Results of this study in the Beijing area indicated that no changes have been made.
Strategies and measures for enhancing hospital emergency management must be studied to prove their rationality. Although the survey response rate was relatively low, it provides information for further studies, and introduces some suggestions to improve hospital emergency management.
Annex : Questionnaire
Section A: Introduction
Thank you for taking some of your most precious time and busy schedule to respond to this questionnaire. It should be noted that:
1. You would be contributing to a study on hospital emergency management, which is unique and unprecedented.
2. Such information would be instrumental in suggestions for improving the preparedness of hospitals in Beijing area for emergencies.
3. The result of this questionnaire will be used for purpose of study only, not for hospital performance evaluation.
4. The name of yours and the hospital you work for will not appear in the report. All information will be in safe keeping.
While responding, please observe the following:
5. Accuracy and completeness of submitted information.
6. Consulting other colleagues who could help in providing relevant Information.
Section B: Personal details and emergency response background
Please complete the following personal details:
1. Your name
2. Your title
3. Department
4. Organization
5. Postal address
6. Telephone number
7. Facsimile number
8. E-mail address
Please answer the following questions in relation to yourself and your hospital:
9. Have you had professional experience of an emergency or disaster?
Yes No
10. Do you have any responsibilities on emergency management in your work?
Yes No
11. What emergencies has your hospital experienced in last 5 years?
Please list.
Section C: Assessment of hospital emergency management
1. Develop hospital emergency management program and adopt systems-based approach to manage it.
1.1. Has your hospital established hospital emergency management program?
Yes No
1.2. Has your hospital defined mid and long time developing objects?
Yes No
1.3. Has your hospital defined emergency responsibilities of every department?
Yes No
1.4. Has your hospital defined emergency responsibilities of every position?
Yes No
1.5. Does your hospital have annual plan of emergency management and address to its implementation?
Yes No
1.6. Does your hospital undertake annual summary or evaluation on emergency management?
Yes No
2 Ensure emergency management program to meet its objectives by institutional arrangement.
2.1. Does your hospital have budget of emergency management?
Yes No
2.2. Has your hospital assigned a leader to be in charge of emergency management?
Yes No
2.3. Is there a special department for emergency management in your hospital?
Yes No
2.4. If there is not a special department for emergency management in your hospital, has your hospital assigned a department to coordinate emergency management?
Yes No
2.5. Does your hospital have full-time personal for emergency management?
Yes No
3 Establish hospital emergency management committee to oversee and guide the activities of emergency management program.
3.1. Is it necessary to establish hospital emergency management committee?
Yes No
3.2. Has your hospital established emergency management committee?
Yes No
3.3. If your hospital has established the committee, does it conduct regularly activities?
Yes No
3.4. According to your judgment, does the committee play a leading role in emergency management?
Yes No
4 Conduct hazard vulnerability analysis and take the results as the base of hospital emergency management.
4.1. What is your awareness level about vulnerability analysis?
No idea General idea Full understanding
4.2. Has your hospital undertaken vulnerability analysis?
Yes No
4.3. If your hospital has not undertaken vulnerability analysis, what is the base for your hospital to develop emergency plan, to conduct training and practice? Please list.
5 Develop comprehensive plan and hazard specific plan, conduct training and exercise, evaluate the hospital's emergency management for continuing improvement.
5.1. Does your hospital have comprehensive plan?
Yes No
5.2. Does your hospital have hazard specific plan?
Yes No
5.3. Does your hospital conduct training according to the plan?
Yes No
5.4. Does your hospital conduct practice according to the plan?
Yes No
5.5. Does your hospital have budget for training and practice?
Yes No
5.6. Does your hospital evaluate emergency management regularly for purpose of continuing improvement?
Yes No
6 Make preparation for the major public health emergencies the hospital faced.
6.1. Does your hospital have demand plan for equipment, medicine, reagent, supply, and vaccine?
Yes No
6.2. Does your hospital have proper store of them?
Yes No
6.3. Does your hospital evaluate the plan and/or store regularly?
Yes No
7 Establish integrated hospital incident command system.
7.1. Has your hospital established the incident command system?
Yes No
7.2. If your hospital has established the incident command system, please describe it brief.
7.3. Has your hospital prescribed emergency response terminology?
Yes No
7.4. Has your hospital regulated information collection, reporting, and announcement SOPs?
Yes No
7.5. According to your judgment, has local government health authority developed an integrated hospital emergency command system and promoted it among the hospitals?
Yes No
8 Coordinate with outside resources for continuity of operation and medical surge.
8.1. Has your hospital contracted with manufactures to take priority of supplement under emergency?
Yes No
8.2. Has your hospital contracted with public department to backup for the key functional systems?
Yes No
8.3. Has your hospital contracted with other hospitals or medical institutes to offering professional supports each other when necessary?
Yes No
8.4. If your hospital has not contracted with other hospitals or medical institutes for supports, what is the way your hospital to get supports when necessary? Please list.
9 Suggestions to hospital emergency management.
9.1. Please list your suggestions to hospital emergency management.
Abbreviations:
SARS = severe acute respiratory syndrome
SOP = standard operating procedure
