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Hospital Assessment and Recovery Guide

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.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Hospital Assessment Assignments

ADMIN

General

___ First: Before assessments begin, ensure that buildings have been deemed safe by the proper authorities (i.e., buildings tested for structural integrity and, if necessary, cleared of any biological, chemical, radiological, or contagious agent contamination). Also ensure that FACILITIES team has turned off the main natural gas and oxygen feeds until these systems have been inspected for leaks.

___ Before cleanup crews and non-medical staff return to the hospital, ensure that all paper medical records (if used) were secured or destroyed prior to evacuation—including those left on patient floors/units. If not, contain all records to protect personal health information. Notes:

Identify a leader for each assessment team, then let these team leaders determine who should serve on the team with them.

Establish a process for assessments, including determining the order of assessments and if full or partial assessment is needed. Organize and orient the teams regarding the assessment process. When all teams have completed these assessments, the ADMIN team will be responsible for coordinating across teams to develop a full recovery plan.

Depending on how long the hospital was closed and the type of damage that was sustained, the hospital may need to be inspected by various Federal, State, and local regulatory and licensing agencies prior to reopening. Administrators are advised to review pertinent laws and regulations to determine required inspections by these oversight bodies and arrange the correct sequencing of these inspections.

Examples of inspections that might be needed:

  • Accrediting organizations.
  • Occupational Safety and Health Administration (OSHA).
  • Centers for Medicare & Medicaid Services (CMS).
  • Public health agency.
  • Pharmacy board.
  • Fire department.

Inspections needed:

Community

A number of community-level issues will need to be considered before the hospital can reopen:

Y / N Are basic municipal services such as fire, law enforcement, and trash collection operational?
Y / N Is communications infrastructure such as telephone (land and cellular) systems and Internet access functional?

  • If not, determine whether the hospital can replace key infrastructure (e.g., by operating an EMS radio repeater station).
Y / N If the entire city or area was evacuated, has enough staff returned to adequately staff the hospital?
Y / N Is safe passage to/from the hospital on local roads possible for patients, staff, and deliveries? (Consider damage to roads as well as extreme civil unrest.)
Y / N Are Emergency Medical Services (EMS) or local ambulance and paramedic services fully operational? (It may not be possible to reopen full emergency department operations until they are.)

Building Exterior

General Observations:
(Describe and record location of signs of damage to buildings and grounds, and general safety or security concerns.)

Building Interior

General Observations:
(Describe and record location of signs of damage, theft, pests/vermin, and general safety or security concerns.)

Administrative Offices

In collaboration with the MATERIALS team, inventory administrative office equipment and supplies (fax machines, copy machines, desktop computers, microwaves, refrigerators, etc.). Create lists of equipment to be repaired and replaced, and needed supplies.

Determine if any laptops or other systems that contain confidential employee information are missing. Notes:

Work with the IT/COMM team to test functioning of administrative computer systems (e.g., payroll), communications systems (e.g., the internal telephone system), and electronic security measures such as user IDs and passwords.

Determine if vendors are needed to restore/repair/replace any administrative computer systems or equipment (e.g., Xerox machines). If yes, names of vendors:

 

 

 

Estimated time to get administrative offices up and running again:

 

 

 

Other

Condition of any hospital-owned vehicles:

 

 

 

Other administrative issues/concerns:

 

 

 

Return to Contents

FACILITIES

General

___ First: Ensure that main oxygen and natural gas supplies have been turned off prior to assessments until these systems have been fully inspected.

___ Check on power supply to refrigerators and freezers throughout the hospital (i.e., clinical and research labs, operating rooms, pharmacy, morgue, blood bank, etc.), and determine if back-up generators are needed to provide immediate support. Notes:



Work with ADMIN team to compile a list of all inspections and testing for hospital systems that are required based on the type and level of damage.

Examples of inspections that might be needed:

  • If air conditioning (AC) cooling tanks were not operational during summer months, the AC system will need to be tested for Legionella pneumophila.
  • If steam or natural gas lines into the hospital were damaged, those systems will need to be inspected before they come back online.
  • If there was flood or earthquake damage, external oil tanks, oxygen tanks, and feeder lines/pipes should be inspected.
  • If there was a loss of power, elevator wells were flooded, or there is other possible damage, elevators need to be re-inspected.

System inspections needed:

Building Exterior

Condition of equipment on the roof (e.g., AC units, electrical boxes, water storage units):


Condition of utility connections (i.e., are any visible power or phone lines down?):


Condition of external utility fixtures, storage units, other equipment located on hospital grounds (e.g., oxygen and fuel storage tanks):


Estimated time to make needed repairs to exterior systems:


Feasibility of portable equipment use (e.g., generator, boiler, chiller) during hospital repairs:


(Check for adequate space, access to power and water feeds, way to provide adequate exhaust.)


Elevators

Test functionality of elevators, and work with vendor to make necessary repairs (Note: If power was out or there is any possibility of damage, elevators should be re-inspected). Notes and name of vendor:

 

 

 

Estimated time to make needed repairs and have elevators inspected (if necessary):

 

 

 

Natural Gas and Electrical Systems and Generators

Coordinate with BIOMED and IT/COMM before bringing power back on to prevent damage to equipment. ((Note: Return power incrementally to avoid overloading system and causing power surges.)

Shut off electrical supply, and check system for damage. Notes:

 

 

 

If the hospital has an onsite power plant, check for damage and functionality. Notes:

 

 

 

If the hospital uses natural gas, check the system for leaks. Notes:

 

 

 

Other observations related to natural gas and electrical systems:



Estimated time to make needed repairs to natural gas and electrical systems:


Check condition and functionality of generators (main generators and backups) throughout hospital. (Note: Fuel injectors may need to be re-primed and generators may need to be re-commissioned if they were used extensively.) Notes:

Check fuel reserves for generators. Notes:

 

 

 

Other observations related to generators:

Other

Condition of any hospital-owned vehicles:

 

 

 

Other administrative issues/concerns:



Steam and Water Supply

If the hospital has an onsite steam plant, check for damage and functionality.
(Note: If the steam system is also used to operate an electricity dynamo, take the dynamo offline, bring back the steam system, and then restart the dynamo.) Notes:

 

 

 

If water was off, check plumbing grid for leaks prior to turning water back on.
(Note: If there is any risk of water contamination, water will need to be tested prior to reopening. Coordinate with BUILDING team to ensure that all faucets are in off position before water is returned.) Notes:

 

 

 

Check water pressure. Notes:

 

 

 

Other observations related to the steam and water supply:

 

 

 

Estimated time to make necessary repairs to steam and water supply systems:

 

 

 

Environmental Control Systems and Refrigeration (HVAC-R)

Condition and functionality of heating system:


(Note: If there was flooding or other damage, boiler will need to be re-commissioned by the vendor.)
Name of vendor:

Condition and functionality of air conditioning system:

 

 

 

(Note: If there was flooding, water loss to cooling towers, or other damage, chiller will need to be re-commissioned.) Name of vendor.

Check thermostats throughout hospital. Notes:

 

 

 

Check central control panel. Notes:

 

 

 

Estimated time to make necessary repairs to heating and cooling systems:

Clear intake air/vent locations throughout the hospital from debris and damage. Notes:

 

 

 

Test main ventilation system to identify any cracks or malfunctions (especially important for positive and negative pressure rooms). Notes:

 

 

 

Test functionality of positive and negative pressure rooms throughout hospital (including air seals). Notes:

 

 

 


Test functionality of high efficiency particulate air (HEPA) filters used throughout hospital. Notes:

 

 

 


Test functionality of ventilation systems in all clinical and research laboratories. Notes:

Estimated time to make necessary repairs to ventilation systems:


Check refrigerators and freezers throughout the hospital (i.e., kitchens, clinical and research labs, operating rooms, pharmacy, morgue, blood bank, etc.); work with vendors to make needed repairs.
Names of vendors:

Estimated time to make necessary repairs to refrigerators and freezers:

Other observations related to environmental control systems (HVAC-R):



Medical Gas System

Test integrity of medical gas system; check pressure and gas mix; check for leaks. Notes:

(Note: Excessive heat during hospital closure could have caused compressor to overheat and shut down medical gas system.)

Test functioning of pressure monitoring system. Notes:

 

 

 

Clean medical gas lines as needed.

Test functionality of medical gas outlets in all applicable patient care areas, including the emergency department, ICUs, operating suites (inpatient and outpatient), post-anesthesia recovery rooms, and patient rooms. (Also test medical gas outlets in areas with "contingency" or "swing" beds where medical gas may not currently be in use.) Notes:

 

 

 

Have vendor recertify oxygen/medical gas system (if necessary). Name of vendor:

 

 

 

Test functionality of medical vacuum and suction systems. Notes:

 

 

 

Other observations related to the medical gas system:

 

 

 

Estimated time to make needed repairs and have medical gas system recertified (if necessary):

 

 

 

(Note: If recertification will be delayed or major repairs are needed, work with FACILITIES and ADMIN teams to determine if portable gases can be used in the meantime.)


Return to Contents

SAFETY

Building Exterior

Signs of illegal/forced entry or vandalism:



Test automatic doors to ensure they close and lock properly and that external access systems (e.g., ID cards) are functioning properly. (Note: It may be necessary to use a temporary ID system for construction workers/temp staff during repairs and assessments.) Notes:

 

 

 

If hospital campus includes "blue light" emergency alarm stations, assure that all are functional. Notes:

 

 

 

Condition of fire escapes:

 

 

 

Condition and functionality of external security cameras and other monitoring devices:

 

 

 

Other observations regarding exterior security/fire safety:

 

 

 

Estimated time to make necessary exterior security/fire safety repairs:

 

 

 

Building Interior

Signs of vandalism or theft throughout the hospital (carefully check all sensitive security areas such as safe, pharmacy, automatic drug dispensing devices, laboratories with chain-of-custody specimens, areas with tissue storage in locked refrigerators/freezers [e.g., fertility clinic], etc.):

 

 

 

Test that automatic ID scanners are working and communicating correctly with electronic employee ID system. Notes:

 

 

 


(Note: It may be necessary to use a temporary ID system for construction workers/temp staff during repairs and assessments.)

Check functionality of internal security cameras, other monitoring devices. Notes:

 

 

 


Check that all emergency doors are closed, alarmed, and functioning properly. Notes:

 

 

 


Condition of emergency exit signage and lighting:





Check condition and functionality of fire alarm system:


(Note:: System may need to be inspected and recertified by fire marshal prior to reopening.)

  • If there was high humidity, smoke/heat detectors may have been damaged; UPS batteries may need to be replaced.

  • Ensure that manual (wall) alarm boxes within the hospital are all connected and functional. Notes:

     

     

     


  • Ensure that system is capable of issuing automatic outputs (e.g., visual and audible alarms, elevator recall, HVAC shut down). Notes:

     

     

     

  • Ensure that automatic communication to municipal fire department or central alarm station is functional; conduct any necessary drills required for recertification. Notes:

     

     

     

Check condition and functionality of fire suppression system:

  • If water was off, it may be necessary to "bleed" air out of the sprinkler system.

  • Check condition and location of fire extinguishers and hoses. Notes:

     

     

     


  • Test functionality of all specialized fire suppression systems, such as those in operating rooms, laboratories, and hospital kitchen(s). Notes:

     

     

     

Other observations regarding interior security/fire safety:

 

 

 

Estimated time to make necessary interior security/fire safety related repairs:

 

 

 

Return to Contents

IT/COMM

General

Note: Do not dispose of unsalvageable equipment. Everything must be inventoried and evaluated for insurance purposes.

___ First: Unplug all computers and sensitive equipment to prevent damage due to power testing and power surges. Find out from FACILITIES when electrical systems will be fully functional.

Test functionality of:

  • Onsite servers (containing employee or patient data). Notes:

     

     

     

  • Internal and external phone system/phone and fax switches. Notes:

     

     

     

  • Emergency radios. Notes:

     

     

     

  • Other external communication systems (including Internet, connection to electronic medical record [EMR] vendors, electronic billing, etc.). Notes:

     

     

     

  • Internal hospital paging system. Notes:

     

     

     

  • Employee ID access to IT/Communications (test login/access from computers in all hospital areas). Notes:

     

     

     

Update employee ID access systems (i.e., staff who have not returned should not have active IDs in the system).

Restore data from offsite backup (if any).

Estimated time to get hospital-wide IT and communications systems up and running:




Administrative Offices

Work with ADMIN team to inventory all missing or damaged laptop/desktop computers, printers, scanners, etc., from all administrative offices.

Work with the ADMIN team to test and correct functioning of administrative computer systems (e.g., payroll), communications systems (e.g., the internal telephone system), and electronic security measures such as user IDs and passwords. Notes:

 

 

 

Test functionality of data connections, wiring, and fiber optics. Notes:

 

 

 

Test functionality of wireless data connections. Notes:

 

 

 

Other IT/COMM concerns in administrative offices:

 

 

 

Estimated time to get administrative IT and communications systems up and running:




Patient Care Areas

Patient Care Areas include: inpatient care, emergency department (ED), intensive care units (ICUs), operating rooms (ORs) and post op, radiology/nuclear medicine, respiratory therapy, outpatient care, other specialty services.

Work with MEDICAL team to inventory all missing or damaged laptop/desktop computers, printers, scanners, etc., from all patient care areas. Notes:

 

 

 

Test functionality of:

  • Data connections, wiring, and fiber optics. Notes:

     

     

     


  • Wireless data connections. Notes:

     

     

     


  • Bedside nurse call system. Notes:

     

     

     


  • Pneumatic tube message system (if used). Notes:

     

     

     


  • All other internal communications systems (e.g., communication between ED/surgery and pathology). Notes:

     

     

     



Work with MEDICAL team to troubleshoot problems with any specialized computer and communications equipment and programs. Notes:

 

 

 

Determine what specialized computer and communication equipment in patient care areas need to be inspected and recertified by vendors prior to use. List of equipment and names of vendors:


Other IT/COMM concerns in patient care areas:


Estimated time to get IT and communications systems in patient areas up and running:



Ancillary Service Areas

Ancillary Service Areas include: pharmacy, morgue, non-radiation emitting imaging technologies, medical records/medical informatics, blood bank/tissue bank, clinical laboratories, and research laboratories.

Work with ANCILLARY team to inventory all missing or damaged laptop/desktop computers, printers, scanners, etc., from all ancillary service areas. Notes:

 

 

 

Test functionality of data connections, wiring, and fiber optics. Notes:


Test functionality of wireless data connections. Notes:


Work with ANCILLARY team and vendors to troubleshoot and correct problems with specialized computer equipment and programs, and communications equipment. List of equipment and names of vendors:


Other IT/COMM concerns in ancillary service areas:



Estimated time to get IT and communications systems in ancillary service areas up and running:





Support Service Areas

Support Service Areas include: kitchen/nutritional services, housekeeping/linens, and patient transport. 

Work with SUPPORT team to inventory all missing or damaged laptop/desktop computers, printers, scanners, etc., from all ancillary service areas. Notes:

 

 

 

Test functionality of data connections, wiring, and fiber optics. Notes:


Test functionality of wireless data connections. Notes:


Other IT/COMM concerns in support service areas:



Estimated time to get IT and communications systems in support service areas up and running:





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