A scoping review of internal hospital crises and disasters in the Netherlands, 2000–2020

Abstract

Background Internal hospital crises and disasters (IHCDs) are events that disrupt the routine functioning of a hospital while threatening the well-being of patients and staff. IHCDs may cause hospital closure, evacuations of patients and loss of healthcare capacity. The consequences may be ruinous for local communities. Although IHCDs occur with regularity, information on the frequency and types of these events is scarcely published in the medical literature. However, gray literature and popular media reports are widely available. We therefore conducted a scoping review of these literature sources to identify and characterize the IHCDs that occurred in Dutch hospitals from 2000 to 2020. The aim is to develop a systematic understanding of the frequency of the various types of IHCDs occurring in a prosperous nation such as the Netherlands. Methods A systematic scoping review of news articles retrieved from the LexisNexis database, Google, Google News, PubMed and EMBASE between 2000 and 2020. All articles mentioning the closure of a hospital department in the Netherlands were analyzed. Results A total of 134 IHCDs were identified in a 20-year time period. Of these IHCDs, there were 96 (71.6%) emergency department closures, 76 (56.7%) operation room closures, 56 (41.8%) evacuations, 26 (17.9%) reports of injured persons, and 2 (1.5%) reported casualties. Cascading events of multiple failures transpired in 39 (29.1%) IHCDs. The primary causes of IHCDs (as reported) were information and communication technology (ICT) failures, technical failures, fires, power failures, and hazardous material warnings. An average of 6.7 IHCDs occurred per year. From 2000–2009 there were 32 IHCDs, of which one concerned a primary ICT failure. Of the 102 IHCDs between 2010–2019, 32 were primary ICT failures. Conclusions IHCDs occur with some regularity in the Netherlands and have marked effects on hospital critical care departments, particularly emergency departments. Cascading events of multiple failures transpire nearly a third of the time, limiting the ability of a hospital to stave off closure due to failure. Emergency managers should therefore prioritize the risk of ICT failures and cascading events and train hospital staff accordingly.

When disasters strike the emergency department: a case series and narrative review

“…IHCDs have the potential to occur at any time, at any location, and in any hospital. EDs are at particular risk [ 8 ]. The causes are multifaceted and an internal disaster is often the result of a cascade of events [ 1 , 3 , 8 , 13 ].…”

“…EDs are at particular risk [ 8 ]. The causes are multifaceted and an internal disaster is often the result of a cascade of events [ 1 , 3 , 8 , 13 ]. In addition, IHCDs are typically further complicated by failure of communication systems, power outage, water loss, physical damage to the facility, hazardous material exposure, evacuation-related problems, resource allocation difficulties, and problems for additional staff reaching the facility [ 1 , 2 ].…”

“…ICT failures are often associated with power failures, and can result in dysfunctional communication systems [ 2 , 13 ]. A complicating factor in ICT failures is that hospitals increasingly rely on connected ICT systems, which are prone to ICT failure cascades [ 8 ]. Furthermore, cyberattacks on hospitals have been on the rise worldwide, affecting numerous hospitals in high-income countries.…”

“…In this same period, the number of hospitals decreased from 107 to 83. Involvement of the ED was reported in 82% of cases, and ED closure could often not be avoided [ 8 ].…”

Three decades of hospital evacuations in the Netherlands: a scoping review

“…3 4 A previous study from the Netherlands revealed that the annual risk for a hospital to experience an IHCD was 16% between 2010 and 2020. 3 There is limited data on the prevalence and causes of hospital evacuations. Vulnerabilities of medical facilities may differ between countries due to certain dominant event types and/or geographical conditions.…”