Article

Novel information and communication technology system to improve surge capacity and information management in the initial hospital response to major incidents

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The initial response of local hospitals to major incidents involving natural and anthropogenic hazards is crucial [1-6]. When a major incident is recognized by a hospital’s headquarters, it is necessary to

increase medical surge capacity and capability before external supports arrive. Thus, the hospital must communicate a variety of information to multiple staff, including those who are off-duty [1, 7]; staffing is key to increasing surge capacity [8-12].

Few investigations of emergency staffing have been conducted [13]. Hospitals have reported using an emergency telephone contact system

-a so-called “phone tree”-or automatic assembly according to predetermined criteria [14]. However, phone trees necessitate direct verbal communication and the information is only communicated to one staff member at a time. In the automatic assembly method, health-care providers are required to collect the necessary information by themselves. Moreover, subsequent information management, such as personnel assignment after emergency staffing, is an essential element in the initial hospital response. Despite this, rarely have effec- tive information management systems been developed [8, 15].

The recent development of information and communication technology (ICT) has been remarkable [16-19]. ICT could be used for emer- gency staffing and subsequent information management [15]. Specifically, we hypothesized that, compared with existing methods, an ICT system would enable prompter and more accurate information transfer with more effective utilization. We developed a new ICT system with three functions: (1) simultaneous notification, (2) response and arrival status management, and (3) personnel assignment and verified its effective- ness in simulation tests (Figs. 1-2 and details [Supplementary data]).

In simulation test 1 (information transmission), our ICT system trans-

mitted information to the staff and back to headquarters significantly more rapidly than the conventional phone tree approach (P b 0.01; Fig. 3). The ICT system transmitted information to study participants signif- icantly more accurately than the phone tree approach (P b 0.05; Fig. 4A-C). In simulation test 2 (the information management of the personnel assignment function), all study participants successfully completed

Fig. 1. Panel A: Schematic diagram of procedure. A headquarters in the hospital activates the system by filling in a request form. The request is securely transferred to a cloud server via the internet. The cloud-based software automatically creates an e-mail based on the content of the request; it then sends the e-mail to staff mobile phones. Responses from staff outside the hospital are transferred to the cloud server, where a record of current response status is created and updated at all times. After staff members arrive, the ICT system can add information regarding their assigned area to aid personnel assignment. Panel B: Received mail text in mobile phone of staff outside hospital.

Fig. 2. System screen of assigned section.Panel A: Overview table of assigned section.http://www.cereja.co.jp/dcs/Assigned_Section_Overview.htmlPanel B: Detailed information about assigned section.http://www.cereja.co.jp/dcs/Assigned_Section_Detail.html

the assignment without errors using both the ICT system and a conven- tional manual approach. However, the ICT system was significantly more rapid than the conventional manual approach in assigning 30 staff members (P = 0.0016; Fig. 4D).

To ensure that a hospital’s disaster control headquarters conduct an effective initial response, it is crucial that they notify in-house hospital

staff, provide the necessary information, and receive responses from those staff [8]. Although the phone tree approach does enable direct verbal communication between individuals, it results in lost time accu- racy. In fact, in a US survey, only 43% of respondents considered the phone tree an effective method of contacting in-house staff in a disaster situation [14].

Fig. 3. Kaplan-Meier probability curve of receipt. Panel A: Staff outside hospital. Panel B. Headquarters.

Fig. 4. Accuracy and quickness of transmitted information. Panel A: Information about disaster type. Panel B: Information about site of incidence. Panel C: Information about assembly location. Panel D: operation time of personnel assignment simulation.

In keeping with their prevalence, mobile phones have been used to improve the initial hospital response to disasters [13, 20]. Specifically, the utility of short message service (SMS) text messaging to notify med- ical staff has been tested in a simulated mass casualty incident using a ready-made SMS mobile phone application [11, 13]. The studies showed that the simultaneous transmission to multiple persons-a basic ICT function-is effective. Similarly, our study showed the utility of simulta- neous transmission using ICT. Moreover, our system had several advan- tages over existing mobile phone applications such as SMS text messaging or messenger applications. Firstly, ICT can notify thousands of people at once, whereas SMS text messaging or messenger applica- tions are limited in the number of destinations which a single message can simultaneously send to [21]. Secondly, our system enables a user with an insufficient experience to transmit information easily, quickly, and accurately, with contents that are both necessary and sufficient without opening the instruction manual. Furthermore, the system was designed with various considerations and specialized to provide high effectiveness during the initial response to disaster. For example, to pro- mote a prompt system activation by headquarters who are uncertain whether they need to send a request of attendance during the initial phase due to insufficient information, the input screen for system activa- tion has a predefined format of a standby request. To provide flexibility, users can select the destination of each transmission from a list of staff categories by clicking a button. To prevent notification failure, the system repeatedly sends e-mail requests after activation (e.g., every 5 min).

We also developed the system to facilitate subsequent assign- ment of staff members who have arrived at the assembly point. Spe- cifically, the system was designed so that the headquarters of hospital disaster control could easily and quickly place staff by checking the inputted information necessary to optimal personnel assignment. The present study results showed that the system signif- icantly shortened operation times.

To conclude, our novel ICT system transmitted information more ac- curately and promptly to staff. Headquarters more quickly received staff responses and the information was effectively utilized for subsequent personnel assignment. It appears that the system improves staff Resource management during the initial hospital response to a major incident.

Support/funding

None to disclose.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi. org/10.1016/j.ajem.2018.06.007.

Mami Yamada, MD