Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents

Abstract

Objectives: Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. More resilient resource allocation strategies, ie, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital’s adaptive resource allocation strategies in responding to a mass casualty incident (MCI). Methods: A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan. Results: In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies. Conclusions: The present study offers a robust approach, effective strategies, and new insights to design more resilient plans to cope with MCIs. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities, such as operational coordination mechanisms, among multiple hospitals in the same geographic area.

Managing Quality Improvement and Risks in the Hospital Emergency Department: A Systematic Literature Review

“…Nine studies analyzed the resilience theme (Table 10): two conceptual papers [102,103], one SLR [104] and six empirical researches: qualitative studies conducted in Italy [105] and UK [106], two mixed method approach in the UK [107,108], one experiment conducted in USA [109] and one study that implemented discrete event simulation and system dynamics methodology in Italian emergency department.…”

“…The reviewed studies analyze social reality and rethink resilience among health professionals identifying system vulnerabilities and quality improvement interventions [102,106]. The studies describe some processes to prevent fatigue in ED nurses and the mental health problems of healthcare professionals, people in isolation, and general citizenship [105,109]. The resilience theme examines the effects of interventions aimed at supporting the resilience and mental health of medical staff identifying barriers and facilitators of these, analyzing also the increase in demand of patients or a reduction in the capacity of beds and the different hospital's adaptive resource allocation strategies in emergency situations [103,104,107,108,110].…”

“…Personal Reflective Debrief process alleviates the stress of nurses promoting their resilience. Increasing nurses' resilience to workplace stress can counter compassion fatigue by providing planned, proactive resources to positively improve resiliency [109]. Even monitoring escalation is essential in understanding how to manage workload, analyzing the barriers and facilitators to improvement [107].…”

Managing quality improvement and risks in the hospital Emergency Department: a systematic literature review

“…The studies describe some models/processes to prevent fatigue in ED nurses and the mental health problems of healthcare professionals, people in isolation, and general citizenship [118,122]. The resilience theme examines the effects of interventions aimed at supporting the resilience and mental health of medical staff, identifying barriers and facilitators of these, also analyzing the increase in demand of patients or a reduction in the capacity of beds and the different hospital's adaptive resource allocation strategies in emergencies [116,117,120,121,123].…”

“…In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the bene t of different resource mobilization strategies [117,123].…”