Hospital Emergency Management Planning Paper

Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu Vol. 24, No. 5
ORIGINAL RESEARCH
Abstract
This study assessed the direct human resource costs of a hospital’s emergency
preparedness planning (in 2005) by surveying participants retrospectively.
Forty participants (74% of the identified population) were surveyed. Using the
self-reported hourly salary of the participant, a direct salary cost was calculated for each participant. The population was 40% male and 60% female; 65%
had a graduate degree or higher; 65% were administrators; 35% were clinicians;
and 50% reported that their job description included a reference to emergency
planning activities. All participants spent a combined total of 3,654.25 hours
on emergency preparedness activities,including 20.1% on personal education/training; 11.6% on educating other people; 39.3% on paperwork or equipment maintenance; 22.2% on attendance at meetings; 5.6% on drill participation; and <1%
on other activities. Considering the participants’ hourly salary, direct personal
costs spent on emergency preparedness activities at the institution totaled
US$232,417. Ten percent, all of whom were physicians, reported no compensation for their emergency preparedness efforts at the hospital level.
As much as these results illustrate the strong commitment of the institution to its community, they represent a heavy burden in light of the oftenunfunded mandate of emergency preparedness planning that a hospital may
incur. Such responsibility is carried to some extent by all hospitals.
Petinaux B: Financial burden of emergency preparedness on an urban, academic
hospital. Prehosp Disaster Med 2009;24(5):372–375.
Department of Emergency Medicine, George
Washington University, Washington, DC
USA
Correspondence:
Bruno Petinaux, MD
Department of Emergency Medicine
George Washington University
2150 Pennsylvania Ave, NW
Floor 2B
Burns Building
Washington, DC 20037 USA
E-mail: bpetinaux@mfa.gwu.edu
Keywords: cost; Emergency Management
Committee; emergency preparedness; financial
burden; hospital; salary
Abbreviations:
EMC = Emergency Management Committee
EOP = emergency operations plan
JC = Joint Commission
NIMS = National Incident Management
System
Received: 31 July 2008
Accepted: 10 September 2008
Revised: 05 December 2008
Web publication: 05 October 2009
Financial Burden of Emergency
Preparedness on an Urban, Academic
Hospital
Bruno Petinaux, MD
Introduction
Hospitals have multiple missions, including patient care, clinical education,
clinical research, and community service. Two of these missions come together when a community faces an emergency or disaster—patient care and community service.The hospital’s patient care role expands as the disaster unfolds.
The hospital’s community service role begins long before a disaster strikes, as
the hospital staff attempts to mitigate hazards and prepare through planning,
equipment, education, training, exercising, evaluations, and updating its emergency operations plan (EOP).1,2
To gain and maintain Joint Commission ( JC) accreditation, hospital staff
must develop an EOP that utilizes an incident management system (IMS)
and integrates the plan within a community’s response plan. An “all hazards”
approach to disaster management is incorporated into this EOP. Further, the
hospital staff performs biannual drills and a yearly review of the EOP. These
planning activities are not reimbursed as they do not represent patient care;
however, they do represent a form of organizational investment for the future,
should a disaster strike, due to the fact that better prepared organizations should
demonstrate greater resiliency and effectiveness during times of disaster.
These activities come at a high cost. Hospital preparedness that meets the
challenge of a pandemic influenza threat has been estimated at US$1,000,000
per hospital.1 The institution that participated in this study always has had a
very strong commitment toward emergency preparedness efforts, due to its
September – October 2009 http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine
Petinaux 373
reviewed to determine whether or not any external funding
was obtained to support the participant’s efforts. The
Institutional Review Board approved this study. Consent
was obtained from all participants.
Results
Fifty-four eligible members of the EMC were identified for
participation in this study. Of these, one reported no time
spent and no income, 11 did not participate, one declined
to participate, and one member (author) abstained. Overall,
40 members (74%) participated. Figure 1 outlines the educational backgrounds of the study population. Sixteen participants were male (40%), 24 female (60%); eight (20%)
participants were physicians.
Sixty-five percent of the participants described their job
functions to be mostly administrative and 50% of participants stated that their job function specifically included
emergency preparedness responsibilities. The study participants reported a combined 3,654.25 hours dedicated to
EOP efforts in 2005. Of the time devoted to emergency
preparedness efforts, 39.3% was spent on paperwork and
maintaining equipment. Approximatley 31.7% was spent
on training, with 20.1% on self-education and 11.6% on
education and others. Twenty-two percent was spent on
meetings, of which about 75% was spent on internal meetings to the hospital and the rest in meetings external to the
facility. Of the remaining time, 5.6% was spent on disaster
drills, 0.8% was spent on disaster activations, and 0.4% on
unspecified activities (Figure 2).
The average salary of the participants was $56.43 per
hour. The collective total amount of money spent during
2005 on direct salary costs was $232,417.20. The salaries
for 29 participants were paid directly by the hospital. Two
participants had multiple funding sources for their salaries
related to emergency preparedness activities at the hospital,
four reported employers other than the hospital to have
paid the salaries, and five reported no compensation. Of
note, all participants not reporting any actual salary compensation for their efforts were physicians. No participant
reported grant income.
location and involvement in the community. As required by
its bylaws, the hospital has formed an Emergency
Management Committee (EMC). This Committee is
tasked with leading all emergency preparedness efforts at
the institution and ensuring JC compliance.The Committee
has been very active in organizing biannual drills, updating
the EOP, educating and training staff, resource management, and representing the hospital to the emergency management community at-large. In addition to the above
efforts, anticipated or sudden unexpected increases in the
EMC’s functions can occur. One example of a sudden,
unexpected event was the response to the anthrax scare in
Northern Virginia in March of 2005. Conversely, an example of an anticipated event was the Presidential
Inauguration in January of 2005.
The above outlined activities to some extent are duplicated at every hospital in the United States, but the salary
costs of maintaining such efforts in the field of emergency
preparedness planning never have been studied in depth in
the field of emergency preparedness planning. A MEDLINE search of the terms “committee” and “disaster” yielded
only two entries,4,5 neither of which addressed the actual
planning process. Prior studies have examined the costs,
including not just salary expenses, incurred by institutions
relating to institutional review board work associated with
research.6–9 A prior study examining the overall cost of
hospital emergency preparedness from the Greater New
York Hospital Association in the post-9-11 era identified
that 25.8% of all expenditures were related to staff
resources.10 The data presented in this study focus exclusively on the direct salary costs of the emergency preparedness efforts at one institution.
Methods
The EMC members were surveyed retrospectively regarding their emergency preparedness efforts during the 2005
calendar year. Participants were asked to estimate their
involvement in meetings, education, training, preparations,
and response to disasters. Using the self-reported hourly
salary of the participant, a direct salary cost was calculated
for each participant. The source of the salary also was
Petinaux © 2009 Prehospital and Disaster Medicine
Figure 1—Educational background of the study population
Petinaux © 2009 Prehospital and Disaster Medicine
Figure 2—Time spent on each EP effort
Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu Vol. 24, No. 5
374 Financial Burden of Emergency Preparedness
thought of as an investment in the future should disaster
strike. Yet, fiscal pressures and the paucity of financial support for dedicated disaster planning at the individual hospital
level,place the majority of the financial burden onto hospitals.
Emergency preparedness is a topic of great study based
on recent disasters in the United States; however, the
researchers who focus on disaster preparedness efforts and
discuss the costs incurred with such efforts tend not to
focus on the cost of the actual emergency planning
process.12,13 This process cost, expressed in salaries alone is
substantial. Equipment maintenance and “paperwork” were
responsible for almost 40% of all efforts. Compliance with
standards, updating and maintaining plans, and resource
management are included within this category. As funding
is available for resourcing, activities such as purchase ordering, tracking, organizing, stocking, inventorying, maintaining, and auditing of resources are labor intensive. Further, to
be utilized efficiently, these resources must be integrated into
the planning process.
Education and training represented almost 32% of the
time commitment that members reported on the EMC.
This training may have included internal or external training. Some of this training is done at the discretion of the
members; some trainings,though,such as the NIMS courses, are obligatory for compliance purposes. If all 54 EMC
members took the IS-100 (3 hours), IS-200 (3 hours), ISDiscussion
Emergency planning represents a large, unfunded, yet necessary financial burden on hospitals. The extent of the
financial burden of emergency preparedness planning on
any institution has not been reported before. By examining
the direct human resource costs associated with emergency
planning, this study attempted to quantify this financial
burden within its study limitations. All institutions must
realize that their emergency planning efforts resulted in
substantial direct costs to their operating budget. To assist
in controlling such costs, recommendations for an EMC to
achieve maximum efficiency of personnel use in the planning and preparation efforts of emergency management are
outlined in Table 1. The National Incident Management
System (NIMS) Implementation Activity Element Six for
hospitals and healthcare systems, as published by the
Federal Emergency Management Agency, directs hospitals
to enact a mechanism through which preparedness funds
provided by the Federal and State governing bodies could
be allocated by hospitals and hospital associations for preparedness efforts.11 However, such funding efforts typically
do not include the actual planning process, but focus primarily on resourcing and hospital infrastructure. By nature,
emergency planning efforts often do not add to the core
business of a hospital, which is direct patient care, as they
are mostly preparatory efforts. This planning could be
Develop a core Emergency Management Committee (EMC) of smaller size to meet monthly
Meet quarterly or less with all Emergency Management Committee Members to address system wide Mitigation, Preparation,
Response, and Mitigation Efforts
Provide the Emergency Management Committee Leadership with administrative resources that can perform non-EMC core
tasks
Involve hospital support departments such as Materials Management and Finance Department in resource management—
integrate ‘Disaster Supplies’ with existing hospital resource management
Integrate Emergency Preparedness Efforts into existing hospital efforts – Life Safety Rounds, Fire Drills, Core Competencies,
Annual Reviews, etc.
Encourage local Hospital Associations to develop a strong local, regional, and state-wide hospital emergency preparedness
committee to manage funding opportunities and their associated requirements, documentation, and auditing
Encourage local Hospital Associations to develop memoranda of understanding between members for local, regional, and
state-wide resource management during a response
Develop IS (NIMS) equivalent courses tailored specifically to your facility to maximize training opportunities
Develop asynchronous learning tools via distance learning specific to your facility that staff members may take at their own
pace and convenience
Consider adopting ‘off the shelf’ plans—though be sure to make these plans organization and facility specific
Consider working with other hospitals in your area to develop common pieces to an emergency management program such
as a hazard and vulnerability analysis, biannual exercise, etc.
Recognize staff members emergency management function to include this responsibility in their job description and provide
for formally protected time to participate in EMC efforts
Petinaux © 2009 Prehospital and Disaster Medicine
Table 1—Planning and preparation management recommendations (EMC = Emergency Management Committee;
IS = independent study; NIMS = National Incident Management System)
September – October 2009 http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine
Petinaux 375
physician relative value units, productivity, malpractice,
travel costs, communication, and office costs also were not
included. Future research should focus on prospective salary
costs of emergency preparedness efforts at an institution.
As the level of preparedness and involvement within preparedness efforts may differ with hospital characteristics, a
multicenter research study may more accurately approximate costs.These costs also should not only be measured in
direct salary costs alone, but should include indirect costs
such as office support, costs of all drill/exercise participants,
and system-wide training, exercising, and planning costs.
Conclusions
Hospitals are committed to strong emergency management
programs due to the risks to which they are exposed. These
risks are measured by the impact of any given hazard on the
facility within its geographic locations including: proximity
to hazards, such as industrial and transportation centers,
and potential exposure to disasters of both natural and
human-made causes, both internal and external. In the participating institution’s staff, salary cost of such a commitment as demonstrated in this study totaled almost a quarter
of a million dollars. In light of such large sums of money,
the healthcare industry should strive to streamline emergency preparedness efforts by providing strong hospital
leadership support.By standardizing plans, developing local
and regional disaster protocols, integrated responses within
the community, and effective resource management across
competing hospital systems, hospitals would benefit from
synergy in their disaster preparation and responses.
Individual hospitals might be served better by establishing
one individual or a small group of individuals who develop
the NIMS compliant community, integrated, all-hazards
EOP and maintain it. It also would be this small group’s or
individual’s responsibility to train all employees on their roles
within the plan as well as meeting with departmental leadership to ensure plan accuracy.
700 (3 hours), and IS-800 (3 hours) courses for a total of 12
contact hours, a one time median salary cost of >$36,000
would be incurred by the facility to meet this implementation activity. Meetings included the monthly EMC meetings, other internal planning and preparatory meetings, as
well as external planning and preparatory meetings with
outside agencies and partners.
Limitations
This was a single-site study; therefore, the results were
influenced by the study population as well as the characteristics of the facility, an urban, academic medical center.
Furthermore, the intensity of planning and preparatory
efforts, though baseline at all hospital facilities within the
US, may be driven differently at certain facilities due to
hazard and vulnerability analysis results. The study environment, being an urban, academic center in a major metropolitan area, might have inflated the preparedness efforts.
The Greater New York Hospital Association (GNYHA)
report found similar trends with academic hospitals outspending community hospitals three to one in their overall
preparedness efforts. Hence, direct applications of this
study must be viewed in the context of size and type of hospital, a hospital’s commitment to emergency preparedness
efforts, and probability and the likely impact of any given
disaster on the hospital.
Further, the study focused only on the members of the
EMC. It must be recognized that facility-wide education
and drilling occurs year round and such costs were not
included in this study. However, most of these activities
would not involve strict planning. The co-chair of the
EMC during most of the study period was the author of
the study, and therefore, did not participate. The author
estimates an additional $30,000 of salary costs that could
have been added to the total if included in the report.
Further costs, such as benefits of up to 28% per employee
were not included in the study. Indirect costs such as loss of
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