Hospital Capacity, Capability, and Emergency Prepardeness

Research Issue: Responding to risk, on either the individual, organizational, or governmental level is often dependent on the likelihood of the event, the costs faced if the event occurs, and the precedence of the event. Whereas Hurricane Katrina “missed” the New Orleans proper, the resulting levee breaks incapacitated its hospitals. This precedence should lead hospital decision-makers in disaster-prone areas to develop contingency plans for patient safety in the event of an evacuation.

Objectives: We assess the possible preparedness plans for Florida hospitals operating along the Atlantic Ocean and Gulf of Mexico coast in case of a major hurricane. We employ mathematical models to measure the available capacity in other cities' hospitals in terms of resources that would be open to absorb evacuated patients. Using Johanson's (1968) notion of capacity as the maximum rate of output possible from fixed inputs (i.e., without restrictions on variable inputs), we measure capacity in a frontier setting using data envelopment analysis (DEA). Whereas, other assessments of plant capacity concern either the entire hospital or specific services, by using medical criteria, we are able to determine specific hospitals' abilities for absorbing individual patients by matching hospital capabilities with service needs.

Methods: We apply two separate DEA models to a sample of Florida hospitals in major metropolitan areas that could be incapacitated by a major hurricane event. First, we directly measure total plant capacity fixing the number of beds, nurses and productive technology in order to estimate capacity in the Florida hospital system. Second, we identify hospitals providing specific services based on patients' medical conditions to determine hospital capability to care for specific patients. Since hurricanes are ‘localized', i.e., they do not affect the entire state, therefore we can simulate the flow of patients between affected and unaffected areas. This initial research can demonstrate how patient safety needs can be met without costly expansion of stand by capacity as well as be used in illustrating a cost-minimizing contingency plan.

Data: Merged data from The Florida Agency for Health Care Administration (data on hospital capacity); Hospital Inpatient Discharge Data (patient characteristics) and finally the Hospital Financial Data for Florida for specific service capabilities.

Results: Due to the seasonal adjustment of hospital capacity in Florida, there was adequate capacity, overall to provide necessary hospital care for evacuated patients. We are also able to better match patient needs with specific hospitals on the basis of treatment requirements and availability.