On August 2, 2021, the US Department of Health and Human Services (HHS), working collaboratively with the Office of Inspector General (OIG), released a toolkit for healthcare facilities’ emergency response. The toolkit provides information to assist communities in responding to the current pandemic and to other emergencies as they arise.
The toolkit contains key insights and lessons learned from OIG’s reports published from 2002 to 2020 about healthcare facility emergency preparedness and response. The reports address healthcare facility actions during outbreaks of emerging infectious diseases (Ebola, H1N1 pandemic influenza, etc.) and natural disasters, as well as bioterrorism preparedness and response. OIG conducted these audits prior to the COVID-19 pandemic.
For reports referenced in this document, OIG conducted audits in accordance with the Generally Accepted Government Auditing Standards issued by the U.S. Government Accountability Office and conducted evaluations in accordance with the Quality Standards for Inspection and Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency.
Key findings with recommendations include:
Facility Operations: Facilities that build response capabilities into routine facility operations are better able to sustain preparedness and respond more effectively.
- Leadership focus in sustained preparedness. It is critical that facility leadership focus on emergency preparedness and response to ensure that facilities sustain preparedness over time, and effectively balance time and resources devoted to emergency management with competing priorities.
- Conducting facility self-assessments. A robust program for facilities to self-assess their preparedness can provide useful insight with immediate effect, and supplement and support HHS oversight such as facility surveys.
- Testing facility systems prior to emergencies. Making time to routinely test for facility, technology, and other problems prior to emergencies helps facilities identify concerns in a controlled environment, train staff, and recognize opportunities for improvement.
- Managing facility data under emergencies. Developing multiple means to manage and access facility data, such as offsite secondary data storage, is vital to making patient care and emergency decisions, ensuring proper payment and oversight, protecting patient privacy, and coordinating resources in an emergency.
- Embedding emergency management into routine practices. Embedding emergency response practices into routine hospital operations, such as adding emergency department screening questions to electronic health record (EHR) systems, can assist facilities in maintaining preparedness and responding effectively.
Facility Staffing: Adequately training and supporting staff are essential components of facilities’ emergency response.
- Training on emergency plans and HHS requirements. Frontline healthcare facility staff may benefit from training on emergency plans and related HHS requirements. Facilities may also benefit from standardized training developed by HHS to address the HHS requirements.
- Training all facility departments together. Conducting training across the facility departments, including both clinical and nonclinical facility staff, creates opportunities for all staff to learn about and understand the needs of each department, and to identify and address potential gaps in roles and responsibilities during an emergency.
- Training and monitoring new staff. Emergency or other special circumstances may require that healthcare facilities employ new and contracted staff to fill needed positions. In doing so it is important that facilities take steps to fully train and closely supervise these staff to ensure that they provide high quality patient care, follow proper protocols, and understand both routine and emergency practices.
- Supporting staff in responding to facility and patient needs during a crisis. During emergencies that disrupt the work and home life of facility staff, such as altering local transportation, healthcare facilities may need to provide staff with additional services to ensure adequate staffing levels, which may require coordination with other local healthcare providers, businesses, and government entities.
Facility Coordination with Community: Facilities’ emergency response should be in coordination with community entities and other providers to maximize resources and knowledge.
- Coordinating with all community partners. Healthcare facility coordination within the community is essential to accessing resources as well as protecting residents/patients and the public, including close coordination with State and local emergency management and other healthcare providers such as long-term care facilities, clinics, physicians’ offices, and laboratories.
- Effectively distributing community resources. Healthcare facility success in responding to emergencies often relies on effective and ongoing coordination of shared community resources, such as transportation and utilities, and shared obligations, such as messaging to the public and providing emergency medical care.
- Using existing networks to maximize resources and learning. Healthcare facilities benefit from seeking out and using all available government and private networks to gain support during emergency responses, such as Health Care Coalitions.
Facility Emergency Planning: Effective facility emergency plans are practical, actionable, comprehensive, and designed to be specific to the facility and community.
- Accounting for all hazards. Developing plans that account for all hazards (emerging infectious diseases, natural disasters) improves healthcare facility strength to perform under unpredictable and changing circumstances.
- Building in resource redundancies. Emergency plans that build in redundancies for accessing needed resources such as supplies, equipment, and staffing, are crucial to ensuring that plans remain practical and actionable as circumstances change.
- Accessing electronic health records. Given increasing healthcare facility reliance on EHR for providing care and ensuring proper payment and reporting, it is essential that facility emergency plans account for EHR needs, such as sharing records across facilities and ensuring access at expanded and temporary facilities.
- Revising plans both during and after emergencies. As emergencies progress, changing circumstances may require that healthcare facilities adjust or redesign emergency plans to continue operations, particularly when community resources become strained, or facilities must provide care for a greater number of patients than planned. Revising plans may also be necessary following an emergency, as the facility assesses the usefulness and adequacy of the plan in preparation for future emergencies.
The Toolkit for healthcare facilities from OIG’s historical work on emergency response can be accessed here.
Compliance Perspective
Issue
The time to review your emergency preparedness plan is now and not during an emergency. If an emergency does happen in your facility, it is critical that all are prepared and ready to take appropriate action. A satisfactory emergency preparedness plan can mean the difference between life and death for residents and staff.
Discussion Points
- Work with your team to review your Emergency Preparedness Plan. Update as needed.
- Train all staff on the Emergency Preparedness Plan. Conduct drills for the various disaster response plans to ensure staff competency with each. Document that these trainings and drills occurred and file the signed documents in each employee’s education file.
- Audit staff understanding to ensure that they are aware of their roles during an emergency per your Emergency Preparedness Plan.
