Effective approaches to emergency preparedness during a pandemic include proactive resource management and involving stakeholders in planning efforts.
The coronavirus disease 2019 (COVID-19) pandemic has exposed emergency preparedness weaknesses in the U.S. healthcare system.
In the early stage of the COVID-19 pandemic, hospitals in New York City struggled mightily to cope with an epic surge of coronavirus patients. Across the country, the pandemic has strained supply chains for critically important materials and equipment such as personal protective equipment (PPE) and ventilators.
There were three primary reasons why health systems and hospitals were ill-prepared for the COVID-19 pandemic, according to Brian Armstrong, RN, MBA, BSN, a healthcare consultant at Philips Healthcare Transformation Services, a business division of Amsterdam, The Netherlands–based Royal Philips Electronics. He has extensive experience in emergency preparedness, including serving as director of emergency services at Prime Healthcare in Atlanta.
1. Dusty emergency management plans
Once emergency management plans are developed and agreed upon, they are frequently stored away and rarely revisited, Armstrong says.
"Instead, these plans should be more frequently practiced and become flexible, living documents that align with evolving operations. Due to the fast pace and busy nature of health systems and hospitals, often plans are reviewed once a year when the healthcare organization runs a drill to meet regulatory requirements. Unfortunately, this lack of ongoing review and reassessment meant that when COVID-19 began to sweep the globe, many health systems did not have adequate plans in place for defining roles or adjusting supply chains."
2. False sense of confidence based on experiences with earlier outbreaks
Before COVID-19, contagion response was not a high priority at health systems and hospitals, he says.
"Prior to COVID-19, there was not much emphasis placed on contagion response. Pandemics are very rare, and we have no recent experience with an overwhelming outbreak of this fashion. While the H1N1, Ebola, and SARS viruses were expected to have a dramatic effect on public health and the healthcare system, the actual effects were less severe than anticipated, which may have lulled organizations into a false sense of security."
3. Regional variation in emergency preparedness
Hospitals and health systems conduct annual vulnerability threat assessments that create a regionally specific priority matrix on what to focus on related to disasters and major threats. These vulnerability threat assessments are not well-suited to national calamities such as the COVID-19 pandemic, Armstrong says.
"This can be quite different depending on location. A hospital in Florida will have hurricanes rate much more highly than a hospital in Ohio, which might see tornados high on the list. A global pandemic was not high on any hospital's threat assessment."
Preparing for future pandemics
Pandemics are not a matter of "if" but "when," he says. "With this reality in mind, it is not too soon for health systems and hospitals to examine what policies and procedures failed them during this COVID-19 event."
There are four main ways health systems and hospitals can be better prepared for future outbreaks, Armstrong says.
1. Proactive resource management
Many health systems and hospitals function with "just-in-time" supply chains. Healthcare organizations should take time to identify and activate supply streams, review stockpile levels, and rotate supplies to avoid expiring items, he says.
2. PPE management
Health systems and hospitals need better command and control for PPE. These organizations spend a lot of time on training about how to use PPE, then must retool when new PPE is substituted, Armstrong says.
Health systems and hospitals should look closely at longer term and renewable PPE such as powered air-purifying respirators and N95 respirator masks as well as methods to extend the life of PPE. One suggestion is to develop a system to forecast PPE usage based on burn rates. This system should be reviewed daily or weekly depending on the usage tempo, he says.
3. Involving stakeholders in planning
It is crucial to involve all departments and decision-makers in emergency preparedness planning and recovery efforts. Involving frontline clinicians in planning improves understanding of their experience during an emergency, helps with engagement and adoption of new processes, and gives medical professionals a vested interest in emergency preparedness rather than just telling them what to do, Armstrong says.
4. Boosting technology infrastructure
Health systems and hospitals should be working now to improve technology infrastructure such as establishing robust telemedicine and remote work capabilities. These investments ensure business and operational continuity during a crisis, he says.
Pandemic lessons learned
From an emergency preparedness perspective, there have been several lessons learned from the COVID-19 pandemic, Armstrong says.
"COVID-19 has taught us that there is no one-size-fits-all emergency management plan—each needs to be customized and adjusted frequently. Rather than having a plan just to check a regulatory box, make emergency management an integrated part of operational strategy and incident command systems a part of everyday work."
The COVID-19 pandemic has demonstrated the importance of vigilance, he says. "Health systems and hospitals need to consider that novel infectious diseases have been relatively common over the past decade, and the ongoing risk of resurgence and the chance of new pathogens requires healthcare leaders to take a new approach to maintaining essential capabilities to respond to an initial outbreak or event."
Vigilance requires ongoing emergency preparedness, Armstrong says. "When previous infections have run their course, the command center has closed, equipment has been put away, and plans have gone back on the shelf. While it may not be necessary to maintain incident command readiness at all times, some aspects of command systems and monitoring need to remain a constant part of daily operations to help ensure infection outbreaks are a staple consideration in daily huddles and reports."
To avoid emergency preparedness pitfalls during future infectious disease outbreaks, health systems and hospitals should avoid a lack of reflection, he says.
"After a crisis, people get complacent, memories fade, and processes slide back into pre-crisis operational structures. It is important that no time is wasted to examine what did not work and put plans in place to mitigate root issues the next time. While an after-action report is important, organizations also need to do mid-action reports and address hard-hit areas to improve response for a potential second wave or future pandemic."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
At health systems and hospitals, the coronavirus pandemic has highlighted emergency preparedness weaknesses such as fragile supply chains.
Causes of emergency preparedness flaws before the coronavirus pandemic include a false sense of confidence based on the experience with earlier outbreaks.
Emergency preparedness lessons learned from the coronavirus pandemic include the realization that there is no one-size-fits-all emergency management plan.