Response plan goes beyond bioterror
A downloadable software program has just been made available to help hospitals and health systems plan antibiotic dispensing and vaccination campaigns to respond to bioterrorism or large-scale natural disease outbreaks.
Funded by the Agency for Healthcare Research and Quality (AHRQ), this new resource, which is available at www.ahrq.gov/research/biomodel.htm, is the nation’s first computerized staffing model that can be downloaded as a spreadsheet and used to calculate the specific needs of local health care systems based on the number of staff they have and the number of patients they would need to treat quickly.
"This model is not specific for bioterror," says Nathaniel Hupert, MD, MPH, assistant professor of public health and Medicine at Weill Medical College of Cornell University in New York City, who led the research team.
"It was really designed to help health care planners conceptualize what their response would be to any outbreak [that required a large-scale reaction]." In fact, while the program is so new it still does not have an official name, Hupert says the team’s favorite is the "bioterrorism and epidemic outbreak response model."
Ideally, he says, the program will have a wide variety of applications, from intentional (i.e., terroristic) origin to natural outbreaks of new illnesses such as severe acute respiratory syndrome (SARS) and newly introduced illnesses such as monkeypox. "It can be used for anything to which the community and the health care system have to respond quickly, efficiently, and effectively when you have to get there fast, using your available resources, and you have to actually get the meds to the people appropriately and try to avoid getting the wrong meds to the wrong people," he explains.
Such outbreaks present a unique set of patient safety challenges, Hupert observes.
"When we talk about patient safety in a hospital, that’s an extraordinarily controlled environment; but when you talk about giving amoxicillin to 2 million people in seven days in different settings, that’s much more challenging," he asserts.
"We tried to give planners the 1,000-foot or even the 10,000-foot view they have to have to process a population of defined size — their community — through a network of rapidly established dispensing centers in a given time frame."
There were a number of specific issues the research team wanted to address, such as:
- How many centers would it take?
- How many total staff would be needed?
- How should dispensing centers be staffed to create the maximum efficiency of the limited staff available?
- If you do not have enough staff, how should staff be reconfigured to best advantage?
"The bottom line is: After the anthrax attacks, all the states and a handful of large cities were told by the Centers for Disease Control and Prevention (CDC) to come up with plans for mass prophylaxis, but there were no tools available," Hupert says.
He recalls teaching a course for the CDC on managing the pharmaceutical stockpile in the summer of 2002 and showing an early version of the program to the group.
Hupert says he was approached by a state pharmacist who expressed the wish that he had had such a tool when his state had made its plan. "They had no idea how many people they needed. That was the driver [for this project]."
The team tested a variety of patient-triage and drug-dispensing plans. Specifically, it evaluated the 2001 New York City and Washington, DC, anthrax responses; subsequent large-scale live disaster drills in New York City and Arizona, in which thousands of volunteers were given fake drugs in response to a hypothetical anthrax attack; and planning models for bioterrorism response developed by California, Florida, Illinois, and other states. Taking elements from these plans, the research team developed two best practice dispensing clinic designs.
On what basis did the team determine which elements of the responses evaluated were best practices? "We were working in a standardless environment," Hupert concedes, "so much of it was based on trying to find examples of processes that had been either evidence-based or exercise-based or good idea-based." In addition, he personally helped plan one large exercise and attended others at which he literally stood with his stopwatch to find out how long different processes took.
The end result is a template into which the health care planner can input information specific to a hospital, a system, or a community. The software can provide the following calculations:
- staff calculations for communitywide prophylaxis;
- number of staff and DVCs (dispensing vaccination centers) required;
- number of staff needed at each station in the chosen DVC design;
- number of DVC support staff needed;
- recommended core and support staff per DVC and for the entire prophylaxis campaign;
- recalculations of time needed to complete and/or total population that can be prophylaxed based on estimated staff available;
- list of processing time and population estimates used for nine modeled scenarios;
- DVC patient flow plans for noncontagious (e.g., anthrax) and contagious (e.g., smallpox) agents;
- sample layout of the model smallpox DVC on the outline of a high-school basketball court;
- recalculations of all model outputs based on customized processing time and population parameters.
The program also describes the operations research concepts and mathematical assumptions underlying the model.
The goal of the program is not to provide universal recommendations to cover all systems and communities, but rather to provide some basic guidelines and raise awareness, Hupert says.
"This is a planning tool that helps crystallize a lot of issues. The purpose of this model is to get people to the table, to get them talking, and to make them aware of some of the resource limitations any community would face," he explains.
The two most challenging areas, he notes, are the number of people and the number of sites available to respond to an outbreak.
"If this model encourages communities to think about and map out where to set up prophylaxis clinics, that would be success," Hupert says. "If it could point out that at least in a hypothetical setting, the given community might not have enough trained government workers on hand to adequately staff a response, that would also be success."
One of the largest issues for communities, he emphasizes, is to know when to cry uncle and call in outside help. "This model can help identify the weak links."
Need More Information?
For more information, contact:
• Nathaniel Hupert, MD, MPH, Assistant Profes-sor of Public Health and Medicine, Weill Medical College of Cornell University, 411 E. 69th St., KB-313, New York, NY 10021. Telephone: (212) 746-3049. Fax: (212) 746-8544.
A downloadable software program has just been made available to help hospitals and health systems plan antibiotic dispensing and vaccination campaigns to respond to bioterrorism or large-scale natural disease outbreaks.
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