United States: Lessons from the COVID-19 Pandemic: Planning for Disaster Preparedness and Emergency Management in Hospitals
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Although the COVID-19 pandemic is still active around the world, leaders and regulators in the healthcare industry have already started to think about how to implement post-pandemic changes in the delivery of care. health care based on lessons learned from the global emergency of the past year and a half. We have reported some of these post-pandemic changes in the healthcare industry in previous blog posts. For example, some temporary solutions to the challenges presented by COVID-19 are made permanent due to their proven efficiency or effectiveness. The expansion of telehealth is a case in point. We have seen the Centers for Medicare and Medicaid Services (“CMS”), as well as state governors and lawmakers, extend and expand certain regulatory exemptions that were originally intended as temporary solutions to allow better access to patient care during pandemic, but which are becoming permanent features because of their usefulness in the innovative delivery of patient care in general.
Other post-pandemic changes in the healthcare delivery landscape will have emerged out of sheer necessity rather than innovation. Perhaps more importantly, we learned that hospitals’ emergency management and pre-COVID disaster preparedness plans were insufficient to handle the scale, intensity and duration of a health disaster like COVID-19. . Currently, CMS requires providers, including hospitals, to develop emergency preparedness protocols, including policies, procedures, and communication plans, as a condition of participating in Medicare and Medicaid. CMS requires hospitals to develop an ‘all hazards approach’, that they describe as “an integrated approach to emergency preparedness planning that focuses on the capacities and capacities essential to prepare for a full range of emergencies or disasters, including internal emergencies and an emergency” man-made (or both) or a natural disaster â. In September 2019, CMS released revised guidelines in the so-called “load reduction rule”, which reduced the requirements that hospitals had to meet in various areas, including emergency preparedness, to enable hospitals to provide care “at the lowest possible cost “. These changes have reduced the requirements for contingency planning, communication, training and testing.
CMS’s regulatory response to the post-pandemic awareness that hospitals need more, not less, comprehensive emergency management and disaster preparedness plans remains to be seen. However, even as the threat of COVID-19 diminishes, the threat of climate change, natural disasters, mass traumatic events and future pandemics still looms. In this critical time, while the challenges presented by the pandemic are still fresh in the minds of leaders who have had to scramble to provide care during a global disaster, regulators, hospital leaders and hospital staff. Hospital management must start thinking about how to create more comprehensive plans to better manage these health crises that may loom on the horizon. Several critical features of the COVID-19 pandemic can serve as useful starting points for developing more comprehensive plans for future disasters:
- Shortages of personnel, medical equipment and PPE: COVID-19 has not only impacted one region of the country, or even the world, as an event with multiple casualties would. Therefore, a typical strategy of tapping into the typical hospital resource network – i.e. other hospitals in neighboring states – for personnel, personal protective equipment (“PPE”), medical equipment (for example, fans) and space reinforcements, did not work. during the pandemic. All hospitals around the world were strapped for resources. Finally, retired providers have been called upon to deal with unprecedented staff shortages in late 2020 and 2021. Hospital leaders need to think about where these reinforcements are coming from during the next health crisis and how these resources can be mobilized quickly and efficiently. Consideration should also be given to the continuing possibility of having to allocate scarce vital resources, such as ventilators, in an ethical manner.
- Shortage of beds: During the COVID-19 pandemic, hospital overcrowding resulted in an unprecedented bed shortage. This was in part because hospitals were unable to release patients who were too sick to go home, but not sick enough to stay in the hospital. In March 2020, New York State required nursing homes to admit residents regardless of their COVID-19 status. This mandate was canceled in May 2020. As we reported in a previous blog post, post-acute care facilities would only admit patients without a negative COVID-19 test, leading to overcrowding in hospitals as patient discharges were delayed pending test results. Hospital leaders should plan for such overcrowding by maintaining surge capacity plans and determining where patients will be redirected if the overcrowding was as severe as it was during this pandemic.
- Continuing uncertainty: The COVID-19 pandemic was unique to many crises in that it was fraught with long-term uncertainties. Unlike a natural disaster or a mass traumatic event, no one knew how long the pandemic would last, how the disease would spread, or what protocols were best to reduce its transmission. As a result, hospitals have struggled to develop protocols and communicate them to all staff and patients in a timely manner. In the event of future health crises with similar degrees of uncertainty, hospital leaders should aim to develop plans to make quick decisions and finally communicate those decisions to all hospital staff and patient populations.
Lessons from the COVID-19 Pandemic: Planning for Disaster Preparedness and Emergency Management in Hospitals
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