Impact Scale for the Continuity of Care in Contingency Management Situations - Operationalization of the Crisis Standards of Care

Abstract

Introduction:

A common language is needed to compare the impacts of incidents, crises, and disasters among health care coalition members, such as emergency medical services, general practitioners, and hospitals. A generic impact scale was developed, based on the Crisis Standards of Care, and was put to the test during the 2017 and 2018 winter/flu-seasons.

Aim:

To define an impact scale for the quantitative assessment of the hospital response to incidents, crises, and disasters.

Methods:

An impact scale has to be generally applicable to be useful in the context of a health care coalition. It should be applicable to all hazards and all parties in proactive and reactive, real-time settings. In addition, the scale should be easy to understand and score and should be independent of the various information systems in use. The Crisis Standards of Care were chosen as basis and were operationalized in a seven-point Likert-scale for expert-based scoring: “No impact,” “Buffer capacity needed,” “Buffer capacity sufficient,” “Unusual adaptations to care needed,” “Unusual adaptations sufficient,” “Disturbance of continuity of care inevitable without external assistance,” and “Disturbance of continuity of care inevitable.”

Results:

During the 2017 and 2018 winter/flu-seasons, crisis managers of ten hospitals scored the scale almost daily for three months. This served as a regional monitor and created the possibility to distribute patients and resources more evenly over the hospitals and with the care sector.

Discussion:

The impact scale improved communication and mutual understanding between hospitals and with other health care organizations, and is expected to have helped in maintaining the continuity of care during the 2017 and 2018 winter/flu-seasons. More research is needed on the reliability of the response. Nevertheless, the scale has since become an integral part of the regional contingency planning.