shows that hospital inpatient admissions may actually decrease during such an event.1)
Federal funding for hospitals and public health entities has been provided through the Hospital Preparedness Program and the Centers for Disease Control and Prevention to date. These have served to improve the position of hospitals and other health entities in relation to equipment and supplies. The restrictions in these programs, however, have discouraged investments in other surge-sensitive areas such as infrastructure, alternative care site planning, or staffing.
Another facet of the surge dilemma is the need for care providers to be able to provide adequate documentation and support to third-party payors. The requirement for fiscal responsibility extends to these entities so they can continue their mission in the maintenance of the healthcare system.
The goal of the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events Financing Surge Capacity and Preparedness section is to “identify funding mechanisms that could be utilized to ensure effective and efficient medical surge capacity preparedness and response.”2
The effects of an acute or extended surge event on hospitals include numerous factors. Staffing may be compromised for a variety of reasons: ill employees, transit impacts, staff reticence to “bring something home,” or a feeling of need to remain home with their families. Supplies (including pharmaceuticals and durable medical equipment) could be negatively affected due to supply chain interruptions, competing demands from all other providers, international transportation interruptions, or raw material shortages. Physical facilities may also be insufficient to support an influx of large numbers of injured or ill persons.
In the wake of Katrina the following access-to-service issues were identified:
Closure of most acute care hospitals, including Charity Hospital
Loss of Level 1 Trauma, mental health beds, other specialty care
Open hospitals operating at reduced capacity, but almost full
Open safety-net clinics decreased from 90 to 19