Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness (PHEP) program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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I. Executive Summary
Purpose: The purpose of this task order was to build upon the initial HAvBED (Hospital Available Beds for Emergencies and Disasters) demonstration project, producing a sustainable bed availability reporting system that would be resident at the U.S. Department of Health and Human Services (HHS) and would be used at a national, regional or local level as a management tool to assist in a system/region's ability to care for a surge of patients in the event of a mass casualty incident. The new system is operational now at https://havbed.hhs.gov/v2/login.aspx.
Background: Denver Health, under a previous Agency for Healthcare Research and Quality (AHRQ) task order, developed a demonstration "real-time" national bed availability system (HAvBED), which was completed on August 30, 2005. The need for such a system was clearly demonstrated as a result of lessons observed from recent disasters. With Hurricane Katrina, it was necessary to evacuate patients from compromised hospitals to other remote institutions. This activity could have been facilitated and expedited through the use of a national bed availability system.
The initial HAvBED demonstration system was developed under the guidance of an advisory group from the private, public and governmental sectors who had interest, experience and expertise in the area of hospital bed availability. This demonstration system is described in detail in the National Available Beds for Emergencies and Disasters Final Report which is available at http://www.ahrq.gov/prep/havbed. In addition to the demonstration bed availability system, the final report included recommendations for bed categories and bed availability as well as conceptual and technical recommendations. These were incorporated into the sustainable production system which is the result of this current task order.
Methodology: An Advisory Group was constituted to provide guidance and feedback to the development group for the duration of this task order. The Advisory Group met four times with the development group at the office of the Assistant Secretary for Preparedness and Response (ASPR) at HHS in Washington, D.C. Denver Health identified a software development subcontractor to assist in the development of the production HAvBED system. The scope, direction and implementation of this system were vetted by the Advisory Group during its meetings.
Results: The production facility bed availability reporting system illustrated in Figure 1 was implemented in test mode and was then transmitted to the Secretary's Operations Center at HHS for installation and operation on their hardware. The functionality of this sustainable system was presented to the HAvBED Advisory Group on October 9, 2007, in Washington, D.C. The completed operational HAvBED system is accompanied by the following documentation:
- User Guide.
- Individual Hospital User Guide.
- Quick Reference Guide.
- Installation (Deployment) Guide.
- Operations Guide.
- Vision Document.
- Requirements Document.
- Software Architecture Document.
- Online Help Document.
- Use Cases Document.
- User Acceptance Test Case Document.
- Web Service Guide.
- Software Delivery Guide.
- Project Glossary.
Recommendations: The HAvBED Project Group, after testing, evaluation, and review of the sustainable production HAvBED system, recommends the following:
- The HAvBED system should be implemented and supported on a national level. This will require that an implementation process and schedule be developed with appropriate HHS support. This process should include education of hospital personnel and local and state health and emergency management personnel about the purpose and utility of the HAvBED system.
- HHS should work with hospitals, state and local departments of health, emergency medical services (EMS) agencies, and emergency managers to inform and educate them of the utility of the HAvBED system. These groups, in turn, will be instrumental in encouraging participation at the local level. This could be done via a series of conferences or meetings. Additional partners in this effort may include the Department of Homeland Security, the American Hospital Association (AHA), state hospital associations, emergency management professional organizations, and selected medical specialty professional organizations. This approach will allow collaborative efforts at multiple levels as well as provide the greatest opportunity for acceptance and widespread implementation of such a system.
- HHS, in concert with potential state, local, and national users, should develop a mechanism for testing the utility of the HAvBED system at these different levels of operation.
- The HAvBED system should not replace any existing bed availability systems, but rather, whenever possible, should acquire and amalgamate data already being gathered by these pre-existing systems, using the HAvBED Web services data interface.
- Careful consideration should be given to the option of having the HAvBED system available for ongoing local and state use, if desired by these entities.
- Hospitals not participating in a multi-institutional bed capacity system should provide necessary data via the HAvBED manual data entry Web interface when requested.
- Incentives for hospital participation in the HAvBED system should be developed and implemented.
- The HAvBED hospital (facility) data base (based upon the AHA hospital data) should be edited and updated:
- Active/inactive status of the institutions should be verified, as this status was determined based upon data supplied by hospitals to the AHA. (Such data are sometimes incomplete.)
- Individual hospitals should verify (and edit where necessary) their AHA bed survey numbers and institutional contact information, including contact E-mail addresses.
- Since the lists of those hospitals that participate in TriCare and the National Disaster Medical System were not made available to the development group, these lists should be obtained and used to indicate the appropriate member affiliations of those institutions in the HAvBED database.
- Additional system augmentation may be considered including:
- Enhanced notification of users concerning activation of the HAvBED system, including, but not limited to, all individuals entering individual hospital bed availability data and state and local emergency managers/emergency operations centers (EOCs).
- Automatic presentation of facility detail data for validation upon logon by any user who has data entry permission for that facility.
- Scaling of facility icons based upon map zoom level to avoid congestion over metropolitan areas.
- Potential improvement of some aspects of system responsiveness by addressing navigation tree refresh issues.
- Further refinement of what resources are displayed based upon facility category (e.g., not showing "mass decontamination status" for nursing homes).
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