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首页> 外文期刊>BMC Health Services Research >Mapping infectious disease hospital surge threats to lessons learnt in Singapore: a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies
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Mapping infectious disease hospital surge threats to lessons learnt in Singapore: a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies

机译：映射传染病医院对新加坡学习的经验教训的兴奋威胁：一个框架的系统分析和发展，以告知如何决定规划和反应策略

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Background Hospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build appropriately matched responses to future ID surge threats. Methods We used the Interpretive Descriptive qualitative approach. Interviews ( n =?35) were conducted with governance and public health specialists; hospital based staff; and General Practitioners. Key policy literature in tandem with the interview data were used to iteratively generate a Hospital ID Surge framework. We anchored our narrative account within this framework, which is used to structure our analysis. Results A spectrum of surge threats from combinations of capacity (for crowding) and capability (for treatment complexity) demands were identified. Starting with the Pyramid scenario, or an influx of high screening rates flooding Emergency Departments, alongside fewer and manageable admissions; the Reverse-Pyramid occurs when few cases are screened and admitted but those that are, are complex; during a ‘ Black’ scenario, the system is overburdened by both crowding and complexity. The Singapore hospital system is highly adapted to crowding, functioning remarkably well at constant near-full capacity in Peacetime and resilient to Endemic surges. We catalogue 26 strategies from lessons learnt relating to staffing, space, supplies and systems, crystalizing institutional memory. The DECIDE model advocates linking these strategies to types of surge threats and offers a step-by-step guide for coordinating outbreak planning and response. Conclusions Lack of a shared definition and decision making of surge threats had rendered the procedures somewhat duplicative. This burden was paradoxically exacerbated by a health system that highly prizes planning and forward thinking, but worked largely in silo until an ID crisis hit. Many such lessons can be put into play to further strengthen our current hospital governance and adapted to more diverse settings.
机译：背景技术在传染病（ID）爆发期间的医院使用和服务需求可以以不同的方式征收卫生系统。在此，我们概念化了医院的浪涌元素，以及从这些事件中吸取的经验教训，以帮助建立对未来身份的兴奋威胁的适当匹配的反应。方法使用解释性描述性定性方法。采访（n = 35）是用治理和公共卫生专家进行的;医院工作人员;和一般从业者。与面试数据串联的主要政策文献用于迭代生成医院ID浪涌框架。我们在本框架内固定了我们的叙述账户，用于构建我们的分析。结果确定了来自容量组合（用于拥挤）和能力（用于治疗复杂性）需求的浪涌威胁。从金字塔情景开始，或高筛分率涌出急救部门的涌入，以及较少且可管理的录取;当筛选和承认少数案件但是那些是复杂的情况时，会发生反向金字塔;在“黑色”情景期间，该系统通过拥挤和复杂性负担过重。新加坡医院系统高度适应拥挤，在平时的近乎充分的能力和适应流行飙升的恒定近乎充分的容量中，运作非常好。我们从有关人员配置，空间，耗材和系统的经验编制的经验编制了26个策略，结晶制度记忆。决定模型倡导者将这些策略与浪涌威胁的类型联系起来，并提供协调爆发规划和响应的逐步指南。结论缺乏共同定义和决策趋势威胁的决策使得程序提出了一些重复的程序。这种负担是由高度奖励规划和前瞻性思考的卫生系统矛盾的，而是在席洛危机中遇到撒洛，这是一个卫生系统。许多这样的课程可以投入游戏，以进一步加强我们当前的医院治理，并适应更多样化的环境。

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