Assessing Hospital and Assessing Hospital and Health System Health System Preparedness and Response Preparedness and Response Nathaniel Hupert, M.D., M.P.H. Nathaniel Hupert, M.D., M.P.H. Assistant Professor of Public Health Assistant Professor of Public Health and Medicine and Medicine Division of Outcomes and Division of Outcomes and Effectiveness Research Effectiveness Research Weill Medical College of Cornell Weill Medical College of Cornell
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Assessing Hospital and Health Assessing Hospital and Health System Preparedness and System Preparedness and ResponseResponse
Nathaniel Hupert, M.D., M.P.H.Nathaniel Hupert, M.D., M.P.H.Assistant Professor of Public Health and Assistant Professor of Public Health and
MedicineMedicine
Division of Outcomes and Effectiveness Division of Outcomes and Effectiveness ResearchResearch
Weill Medical College of CornellWeill Medical College of Cornell
Guiding QuestionsGuiding Questions
How can/should we assess hospital How can/should we assess hospital capacity for bioterrorism response?capacity for bioterrorism response?
What is the role of private hospital networks What is the role of private hospital networks in bioterrorism response?in bioterrorism response?
What is the capacity of existing integrated What is the capacity of existing integrated healthcare delivery systems to provide healthcare delivery systems to provide patient care after a large-scale bioterrorist patient care after a large-scale bioterrorist attack?attack?
Hospital Treatment ModelHospital Treatment Model Variables:Variables:
– Patient load: New York Presbyterian Healthcare Patient load: New York Presbyterian Healthcare System (NYPHS) has 20% NY Metro market System (NYPHS) has 20% NY Metro market shareshare
– Staffed bed availabilityStaffed bed availability– Success of post-exposure prophylaxisSuccess of post-exposure prophylaxis– Timing of disease onset Timing of disease onset – Disease treatment/hospital length of stay (LOS) Disease treatment/hospital length of stay (LOS)
and mortalityand mortality Information SourcesInformation Sources
– NYPHS “Surge Capacity” surveyNYPHS “Surge Capacity” survey– CDC estimates of anthrax case ratesCDC estimates of anthrax case rates– Hospital treatment/LOS/mortality from 2001 Hospital treatment/LOS/mortality from 2001
attack (e.g. >24 hours sick without treatment attack (e.g. >24 hours sick without treatment death)death)
New York Presbyterian Healthcare New York Presbyterian Healthcare System Bed Surge Capacity System Bed Surge Capacity
If NYPHS were responsible for 50,000 potential If NYPHS were responsible for 50,000 potential casualties, outpatient prophylaxis would have to casualties, outpatient prophylaxis would have to reach >90% of those exposed to prevent anthrax reach >90% of those exposed to prevent anthrax cases from exceeding available bed supply.cases from exceeding available bed supply.
NYPHS Surge Capacity Exceed if Post-Exposure Prophylaxis Falls Below 90%
0
500
1000
1500
2000
2500
85% 86% 87% 88% 89% 90% 91%
Proportion Receiving Post-Exposure Prophylaxis
Require Transfer
or Die Waiting
for Bed
Outpatient Distribution Model Outpatient Distribution Model Variables:Variables:
– ~70 staff per shift~70 staff per shift– ~7 minutes per ~7 minutes per
patientpatient– ~ 1000 pts/hr~ 1000 pts/hr
Crea te Clients
Triage Proc es s
Ent er M odel
Populat ionDiver s if y Client
1m in t o Dr ug Desk
Dispensing1m in To Dr ug
Dr ug Dispensing 1m in t o Ex it
Hospit al Bus Bay
Hom e
Rec ord by Lev e l
BusSen t to Hos p ita l v ia
Sen t Home
Cy c le TimeRec ord Hos pita l Bus
TimeRec ord Home Cy c le
Outpatient Dynamic Simulation Model
Triage Queue
Send t o PO D
G r iage St at ion
T ru e
F a ls e
Griage Determinationto Ev aluation
If Sic k Trans port
1m in To Tr iage
Tr iage
1m in To Evaluat ionENTRY:
Cl i ent Attri butes
Am bulance St at ion Hos pita lAmbulanc e to
Am bulance BayTo Hospit al
T ru e
F a ls e
Send fo r Ev a lua tion? Send to Ev a luationUnit
1m in To Evaluat ion
Tr iage t o Eval
and DrugsMed ic a l Ev a luation
Medical Evaluation Queue
T ru e
F a ls e
Sick ?
Dete rmined Sic k
1m in To Bus Bay
Bus St at ion Bus to Hos p ita l To Hospit al Bus BayBatc h 1
Wait for Bus
Sic kDetermined Not
Separate 1
BayHospit al Am bulance
Ambulanc eSen t to Hos p ita l v ia
TimeAmbulanc e Cy c le
Rec ord Hos pita l
Triage Fin is hed
G r iage t o Eval.
T ru e
F a ls e
Need Ambu lanc eBay
1m in To Am bulance
Dispens ingPharmac y
TRIAGE:
MEDICAL EVALUATION:
DRUG DISPENSING:Drug Dispensing Queue
Wait for AmbulanceTRANSPORTATION:
EXIT
MODEL INITIATION
T ru e
F a ls e
Drug Alle rgy ?Giv e Spec ia l Rx
Special RxPhar m acy f or
to To ta l Outpu tAdd to Ambu lanc e
Tota l OutputAdd to Bus to
Tota l OutputAdd Ambula tory to
("t, y")Triage Staff
MODEL TIME
("e, r")StaffEvaluation
("g, h")Griage Staff
Buses
(Ambulance)EMT
Ambulances
DriversBus
("o, p")DispensingDrug
0
0
0
0
0
0 0
0
0
0 0
0
0
0 0
0 0
0
0
0
0
0
0
0
0
0 0
0
00:00:00
0 0 0 0 0
0 0
ConclusionsConclusions These are the first scalable computer models of These are the first scalable computer models of
civilian medical response to bioterrorism civilian medical response to bioterrorism Our outpatient prophylaxis model was Our outpatient prophylaxis model was
implemented during 2001 NYC anthrax attacksimplemented during 2001 NYC anthrax attacks Next: Improve this model using “live run” Next: Improve this model using “live run”
datadata Our hospital model pinpointed the limits of Our hospital model pinpointed the limits of
system capacity in response to a hypothetical system capacity in response to a hypothetical bioterrorist mass casualty eventbioterrorist mass casualty event
Accuracy of the model depends on the quality of Accuracy of the model depends on the quality of information (e.g., type of agent, natural history information (e.g., type of agent, natural history of disease, and treatment requirements) usedof disease, and treatment requirements) used
