Hospitals need to establish a disaster-related information network, conduct simulations and monitor the effects of disasters on patients served by the hospital. This also needs to be done during the COVID-19 pandemic. Although no hospital in the world is ready to deal with COVID-19, hospital readiness has increased over the past year since the pandemic began, which contrasted with patient safety which has not yet improved. Besides, the negative impact of the COVID-19 pandemic on all elements of the healthcare system may also increase the number of patient safety incidents. This study aims to review the impact of hospital readiness on patient safety incidents from the perspective of healthcare workers.
The study used a mixed-methods explanatory sequential design. We conducted an online survey of 235 healthcare workers at COVID-19 referral hospitals, followed by an interview with 11 participants from various hospital types. In the quantitative phase, the questionnaire included 45 questions divided into 3 categories: hospital details, hospital readiness (incident management system, surge capacity, infection prevention, and human resources management), and patient safety incidents. During the qualitative phase, the participants were asked to respond to four questions regarding hospital readiness, patient safety incidents, and recommendations for improving the hospital’s current situation.
Quantitive analysis result
Approximately 66.4% of the participants worked in provincial or district government-owned hospitals, 69.4% worked in hospitals with excellent accreditation status and 69% worked in medium-sized hospitals with 100–200 beds. In addition, 54% of the hospitals had more than 10 ICU beds set aside for COVID-19 patients. Most of the participants (88.1%) are currently or have previously worked in COVID-19-related units. The number of COVID-19 patients treated ranged from fewer than 5 to more than 10. The hospital’s readiness was assessed using four criteria: incident management system, surge capacity, infection control and prevention, and human resource management. More than 80% of the hospitals scored well in the categories of incident management system (86%), surge capacity (80.9%), infection control and prevention (97.9%), and human resource management (84.7%). However, only 50.6% of the hospitals scored well in terms of patient safety incidents. This study also analyzes the confirmatory factor (CFA) to measure the association between the latent variable. It was found that there is a significant effect of hospital ownership, accreditation status, and hospital readiness on patient safety.
Each hospital had a unique approach to managing human resources during the pandemic. For example, the district government hospital, which received accreditation for the first time indicated that the hospital employed medical, nursing, and midwifery apprentices to manage the surge. Other hospitals recruited volunteers from the Nusantara Sehat Team-based Deployment Program, a program by the Ministry of Health. Typically, the healthcare workers treated either COVID-19 patients or non-COVID-19 patients. In terms of training, most of the hospitals either provided adequate pandemic preparedness training or sent DHO healthcare worker training to major cities throughout the regions for training. Participants in only one privately owned, prime-accreditation hospital reported that no training was provided to healthcare workers during the pandemic; however, the hospital established standard operating procedures and expected the healthcare workers to learn and understand these procedures. Most hospitals have an effective infection prevention and control program; however, the availability and quality of PPE have become a major issue in certain hospitals, particularly in the early stages of the pandemic. Surge management techniques have been implemented in a number of hospitals. The key activities included the addition of facilities such as isolation rooms, COVID-19 emergency rooms, COVID-19 intensive care units (ICUs), and ventilators. The hospitals use a variety of methods, including recruitment of new healthcare personnel, volunteers, new graduates, and staff on loan from other hospitals. Meanwhile, the patient safety incidence found in the study shows that most incidents were caused by error administration and delayed treatments.
Author: Inge Dhamanti, PhD
Detail of article can be viewed: https://bmjopen.bmj.com/content/12/7/e061702
