On May 1, 2002, Nathaniel Hupert, M.D., M.P.H., made a presentation in a Web-assisted teleconference at Session 3, which was entitled "Assessing Hospital and Health System Preparedness and Response."
This is the text version of Dr. Hupert's slide presentation. Select to access the slides or to access the streaming video of Bioterrorism and Health System Preparedness.
Nathaniel Hupert, M.D., M.P.H.
Assistant Professor of Public Health and Medicine
Division of Outcomes and Effectiveness Research
Weill Medical College of Cornell
Guiding Questions
Large-Scale Anthrax Attack Scenario
This slide shows a diagram of a the possible scenarios for a large-scale anthrax attack. It assumes that 250,000 are exposed, and 7.75 million are non exposed. The exposed individuals would be the targets for prophylaxis. Individuals who receive no treatment will end up in the hospital and could possibly die without treatment. Some individuals who receive antibiotics distributed in an outpatient setting could still present at the hospital, but others will be fine and will not need to go to the hospital.
Static vs. Dynamic Hospital Capacity
A static estimate of the capacity of hospitals for bioterrorism response takes into account the estimated total casualties requiring hospitalization and the estimated total hospital beds and supplies.
Problem with Static Estimates:
This slide shows a graph of the number of bioterrorism-related anthrax cases, by date of onset and work location—District of Columbia, Florida, New Jersey, and New York City, September 16-October 25, 2001.
The problem with static estimates is knowing at what point in time to measure casualties.
Alternative: Dynamic Capacity Estimates
This slide shows a diagram of dynamic capacity estimates. Between exposure and disease onset it is necessary to measure the daily case onset rate, and between disease onset and hospital bed it is necessary to measure the daily bed capacity.
Hospital Treatment Model
Variables:
Information Sources.
New York Presbyterian Healthcare System Bed Surge Capacity
This slide shows a graph of New York Presbyterian Healthcare System's bed surge capacity. At baseline, NYPHS shows approximately 2000 beds, and the average network bed occupancy at baseline is 74 percent. After 24 hours, the bed capacity has surged to approximately 3500 beds, and after 72 hours its over 4,000.
Hospital Treatment Model (Arena©)
This slide shows a diagram of the hospital treatment model, which displays information on the number of patients send to hospitals, the number of hospital beds available, the number of patients waiting for a bed, and the average waiting time.
Hospital Capacity: Scenario Results
If NYPHS were responsible for 50,000 potential casualties, outpatient prophylaxis would have to reach >90 percent of those exposed to prevent anthrax cases from exceeding available bed supply.
This slide displays a graph that plots the number of patients who require a transfer or die waiting for a bed against the proportion of patients who receive post-exposure prophylaxis. As the proportion increases, the number of patients who require transfer or die decreases.
Outpatient Distribution Model
Variables:
Basic Template:
Outpatient Dynamic Simulation Model
This slide shows an illustration of the outpatient dynamic simulation model. The model looks at the elements of the different phases of a patients hospital experience, including entry, triage, medical evaluation, drug dispensing, transportation, exit.
Conclusions
Current as of June 2002
Internet Citation
Assessing Hospital and Health System Preparedness and Response. Presentation by Nathaniel Hupert at Web-Assisted Teleconference, "Bioterrorism and Health System Preparedness: Emerging Tools, Methods, and Strategies." Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/bioteleconf/session3/huperttxt.htm
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