Deriving an Evidence Base for Emergency Management in U.S. Hospitals: Toward Resilience in the Midst of COVID-19

随着美国医院迅速制定计划并应对COVID-19大流行，许多医院都在努力应对 在管理危机的同时维护患者的健康和安全的重大挑战 和医院工作人员。这一事件表明，医院有必要制定有效的应急措施， 管理（EM）计划，以应对当前的危机和未来的灾难事件。联邦机构和 其他人已经发布了关于医院EM的指南，但这些指南经常变化，有时 报告的内容不一致，没有说明有效管理紧急情况的程序和预期成果。 因此，医院在应对COVID-19时采用了各种EM实践，产生了不同的影响。 当比较农村和城市医院时，EM的变化尤其突出，这不仅在 资源和COVID-19病例激增，但农村医院通常位于 如果COVID-19疫情爆发，患有基础疾病的患者的高风险人群会增加， 19、签约因此，了解医院EM在应对COVID-19方面的作用至关重要， 和乡村环境。基于先前的研究，我们假设成功的EM项目具有显著的 美德.先知-愿首先，有效的新兴市场实践展示了弹性的要素，或应对 中断事件，对性能的负面影响最小。第二，有效EM包括以下混合物： 标准化协议和报告结构等正式机制，以及非正式机制， 例如适应性例程和灵活的角色。 我们的研究检查了12个城市和农村医院的EM实践，以确定有效的技术， 使这些组织能够提供高质量的护理，并在治疗期间和治疗后向恢复力迈进的流程 2019冠状病毒病。我们将使用定性和定量的方法来研究如何结合EM 医院采用的做法有助于恢复能力，改善健康结果， 整体表现。我们首先计划直接与医院高管和临床负责人进行访谈 在COVID-19期间参与EM，因此我们可以识别和比较每个研究中的EM实践 主题分析（Aim 1）。接下来，我们将使用目标1中的访谈数据设计调查， 我们将管理每个医院的关键人员。使用因子分析，我们将开发一个有效的量表， 评估不同新兴市场实践、正式和非正式机制以及复原力的显著性（目标2）。最后， 我们将进行补充的定量分析，以检查病人的结果和医院的表现， 与我们在目标2中开发的EM量表相关，以便我们能够确定哪些实践和机制 是最有效的。从这些调查结果中，我们将确定核心要素和基准， 成功的EM方案，以广泛传播（目标3）。通过我们的研究，我们的目标是为医院提供 以证据为基础的EM实践，将更好地为当前的危机和未来的灾难做好准备。

As U.S. hospitals moved quickly to make plans and respond to the COVID-19 pandemic, many struggled with significant challenges in managing the crisis simultaneously with maintaining the health and safety of patients and hospital staff. This event has demonstrated the need for hospitals to develop effective emergency management (EM) programs to deal with the current crisis and future disaster events. Federal agencies and others have published guidelines on hospital EM, but these guidelines frequently change, are sometimes inconsistent, and do not describe the process for effectively managing emergencies and expected outcomes. Consequently, hospitals have invoked a variety of EM practices in dealing with COVID-19, with varying impact. The variation in EM is especially salient when comparing rural and urban hospitals, which not only differ in terms of resources and the surge in COVID-19 cases, but rural hospitals are typically located in areas with a larger high-risk population of patients with underlying conditions who can have greater complications if COVID- 19 is contracted. Therefore, it is critical to understand hospital EM in response to COVID-19 across both urban and rural settings. Building on prior research, we hypothesize that successful EM programs have distinguishing attributes. First, effective EM practices demonstrate elements of resilience, or capabilities to respond to disruptive events with minimal negative impact to performance. Second, effective EM includes a mixture of formal mechanisms such as standardized protocols and reporting structures, as well as informal mechanisms, such as adaptive routines and flexible roles. Our research examines the EM practices of 12 urban and rural hospitals to identify effective techniques and processes that enabled these organizations to provide quality care and move toward resilience during and after COVID-19. We will use qualitative and quantitative approaches to examine how the combination of EM practices employed by hospitals contributed to resilience, improved health outcomes, and stronger hospital performance overall. We first plan to conduct interviews with hospital executives and clinical leaders directly involved in EM during COVID-19 so we can identify and compare EM practices across each of the study hospitals using thematic analysis (Aim 1). Next, we will use the interview data in Aim 1 to design surveys which we will administer to key personnel at each hospital. Using factor analysis, we will develop a validated scale to assess the saliency of different EM practices, formal and informal mechanisms, and resilience (Aim 2). Last, we will conduct complementary quantitative analyses to examine patient outcomes and hospital performance in relation to the EM scales we developed in Aim 2, so that we can determine which practices and mechanisms of implementing EM were most effective. From these findings we will identify core elements and benchmarks of successful EM programs for broad dissemination (Aim 3). Through our research, we aim to provide hospitals with evidence-based EM practices that will better equip them for the current crisis and future disasters.