(Mt) – Graduate School USA Hospital Emergency Management Discussion

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ORIGINAL RESEARCH Financial Burden of Emergency Preparedness on an Urban, Academic Hospital Bruno Petinaux, MD Department of Emergency Medicine, George Washington University, Washington, DC USA Correspondence: Bruno Petinaux, MD Department of Emergency Medicine George Washington University 2150 Pennsylvania Ave, NW Floor 2B Burns Building Washington, DC 20037 USA E-mail: [email protected] Keywords: cost; Emergency Management Committee; emergency preparedness; financial burden; hospital; salary Abbreviations: EMC = Emergency Management Committee EOP = emergency operations plan JC = Joint Commission NIMS = National Incident Management System Received: 31 July 2008 Accepted: 10 September 2008 Revised: 05 December 2008 Web publication: 05 October 2009 Prehospital and Disaster Medicine Abstract This study assessed the direct human resource costs of a hospital’s emergency preparedness planning (in 2005) by surveying participants retrospectively. Forty participants (74% of the identified population) were surveyed. Using the self-reported hourly salary of the participant, a direct salary cost was calculated for each participant. The population was 40% male and 60% female; 65% had a graduate degree or higher; 65% were administrators; 35% were clinicians; and 50% reported that their job description included a reference to emergency planning activities. All participants spent a combined total of 3,654.25 hours on emergency preparedness activities,including 20.1% on personal education/training; 11.6% on educating other people; 39.3% on paperwork or equipment maintenance; 22.2% on attendance at meetings; 5.6% on drill participation; and $36,000 would be incurred by the facility to meet this implementation activity. Meetings included the monthly EMC meetings, other internal planning and preparatory meetings, as well as external planning and preparatory meetings with outside agencies and partners. Limitations This was a single-site study; therefore, the results were influenced by the study population as well as the characteristics of the facility, an urban, academic medical center. Furthermore, the intensity of planning and preparatory efforts, though baseline at all hospital facilities within the US, may be driven differently at certain facilities due to hazard and vulnerability analysis results. The study environment, being an urban, academic center in a major metropolitan area, might have inflated the preparedness efforts. The Greater New York Hospital Association (GNYHA) report found similar trends with academic hospitals outspending community hospitals three to one in their overall preparedness efforts. Hence, direct applications of this study must be viewed in the context of size and type of hospital, a hospital’s commitment to emergency preparedness efforts, and probability and the likely impact of any given disaster on the hospital. Further, the study focused only on the members of the EMC. It must be recognized that facility-wide education and drilling occurs year round and such costs were not included in this study. However, most of these activities would not involve strict planning. The co-chair of the EMC during most of the study period was the author of the study, and therefore, did not participate. The author estimates an additional $30,000 of salary costs that could have been added to the total if included in the report. Further costs, such as benefits of up to 28% per employee were not included in the study. Indirect costs such as loss of References 1. Lewis P, Aghababian RV: Disaster planning part I: Overview of hospital and emergency department planning for internal and external disasters. Emerg Med Clin North Am 1996;14(2):439–452. 2. Auf der Heide E: Disaster planning PART II: Disaster problems, issues, and challenges identified in the research literature. Emerg Med Clin North Am 1996;14(2):453–480. 3. Toner E, Waldhorn R: What hospitals should do to prepare for an influenza pandemic. Biosecur Bioterror 2006;4(4):397–402. 4. Dabelstein N: Evaluating the international humanitarian system: rationale, process and management of the joint evaluation of the international response to the Rwanda genocide. Disasters 1996;20(4):286–294. 5. Jorgensen CJ: The OR and disaster. Hospitals 1969;43(24):102–105. 6. Brown JH, Schoenfeld LS, Allan PW: The costs of an institutional review board. J Med Edu 1979;54(4):294–299. September – October 2009 physician relative value units, productivity, malpractice, travel costs, communication, and office costs also were not included. Future research should focus on prospective salary costs of emergency preparedness efforts at an institution. As the level of preparedness and involvement within preparedness efforts may differ with hospital characteristics, a multicenter research study may more accurately approximate costs. These costs also should not only be measured in direct salary costs alone, but should include indirect costs such as office support, costs of all drill/exercise participants, and system-wide training, exercising, and planning costs. Conclusions Hospitals are committed to strong emergency management programs due to the risks to which they are exposed. These risks are measured by the impact of any given hazard on the facility within its geographic locations including: proximity to hazards, such as industrial and transportation centers, and potential exposure to disasters of both natural and human-made causes, both internal and external. In the participating institution’s staff, salary cost of such a commitment as demonstrated in this study totaled almost a quarter of a million dollars. In light of such large sums of money, the healthcare industry should strive to streamline emergency preparedness efforts by providing strong hospital leadership support. By standardizing plans, developing local and regional disaster protocols, integrated responses within the community, and effective resource management across competing hospital systems, hospitals would benefit from synergy in their disaster preparation and responses. Individual hospitals might be served better by establishing one individual or a small group of individuals who develop the NIMS compliant community, integrated, all-hazards EOP and maintain it. It also would be this small group’s or individual’s responsibility to train all employees on their roles within the plan as well as meeting with departmental leadership to ensure plan accuracy. 7. Wagner TH, Bhandari A, Chadwick GL, Nelson DK: The cost of operating Institutional Review Boards. Acad Med 2003;78(6):638–644. 8. Sugarman J, Getz K, Speckman JL, Byrne MM, Gerson J, Emanuel EJ: The cost of Institutional Review Boards in academic medical centers. N Engl J Med 2005;352(17)1825–1827. 9. Speckman JL, Byrne MM, Gerson J, Getz K, Wangsmo G, Muse CT, Sugarman J: Determining the costs of Institutional Review Boards. IRB 2007;29(2):7–13. 10. Greater New York Hospital Association: Hospital Expenditures for Emergency Preparedness. February 2003. 11. NIMS Implementation Activities for Hospitals and Healthcare System. Available at http://www.fema.gov/pdf/emergency/nims/imp_hos_fs.pdf. Accesed September 2006. 12. De Lorenzo RA: Financing hospital disaster preparedness. Prehosp Disaster Med 2007;22(5):436–439. 13. Kaji AH, Koenig KL, Lewis RJ: Current hospital disaster preparedness. JAMA 2007;298(18):2188–2190. http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine

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