Assessing Hospital and Health System Preparedness and Response 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 How can/should we assess hospital capacity for bioterrorism response? How can/should we assess hospital capacity for bioterrorism response? What is the role of private hospital networks in bioterrorism response? What is the role of private hospital networks in bioterrorism response? What is the capacity of existing integrated healthcare delivery systems to provide patient care after a large- scale bioterrorist attack? What is the capacity of existing integrated healthcare delivery systems to provide patient care after a large- scale bioterrorist attack?

Large-Scale Anthrax Attack Scenario 250,000 Exposed to Anthrax 7.75 Million Non-Exposed Outpatient Antibiotic Distribution + No Treatment No illness TARGET FOR PROPHYLAXIS Death Hospital Home Hospital

ESTIMATED TOTAL CASUALTIES REQUIRING HOSPITALIZATION ESTIMATED TOTAL HOSPITAL BEDS AND MEDICAL SUPPLIES CAPACITY FOR BIOTERRORISM RESPONSE STATIC ESTIMATE: CAPACITY FOR BIOTERRORISM RESPONSE Static vs. Dynamic Hospital Capacity

Problem with Static Estimates: Do you measure casualties here? Or here?

HOSPITAL BED DISEASE ONSET EXPOSURE Daily Case Onset Rate Daily Bed Capacity Alternative: Dynamic Capacity Estimates

Hospital Treatment Model Variables: Variables: – Patient load: New York Presbyterian Healthcare System (NYPHS) has 20% NY Metro market share – Staffed bed availability – Success of post-exposure prophylaxis – Timing of disease onset – Disease treatment/hospital length of stay (LOS) and mortality Information Sources Information Sources – NYPHS “Surge Capacity” survey – CDC estimates of anthrax case rates – Hospital treatment/LOS/mortality from 2001 attack (e.g. >24 hours sick without treatment  death)

New York Presbyterian Healthcare System Bed Surge Capacity

Hospital Treatment Model (Arena©)

Hospital Capacity: Scenario Results If NYPHS were responsible for 50,000 potential casualties, outpatient prophylaxis would have to reach >90% of those exposed to prevent anthrax cases from exceeding available bed supply.

Outpatient Distribution Model Variables: Variables: – Staffing – Triage protocol – Drug availability – Patient arrival pattern – Patient characteristics Basic Template: Basic Template: – ~70 staff per shift – ~7 minutes per patient – ~ 1000 pts/hr

Conclusions These are the first scalable computer models of civilian medical response to bioterrorism These are the first scalable computer models of civilian medical response to bioterrorism Our outpatient prophylaxis model was implemented during 2001 NYC anthrax attacks Our outpatient prophylaxis model was implemented during 2001 NYC anthrax attacks  Next: Improve this model using “live run” data  Next: Improve this model using “live run” data Our hospital model pinpointed the limits of system capacity in response to a hypothetical bioterrorist mass casualty event Our hospital model pinpointed the limits of system capacity in response to a hypothetical bioterrorist mass casualty event Accuracy of the model depends on the quality of information (e.g., type of agent, natural history of disease, and treatment requirements) used Accuracy of the model depends on the quality of information (e.g., type of agent, natural history of disease, and treatment requirements) used