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Psychological Effects of Patient Surge in Large-Scale Emergencies: A Quality Improvement Tool for Hospital and Clinic Capacity Planning and Response

Published online by Cambridge University Press:  28 June 2012

Lisa S. Meredith*
RAND Corporation, Santa Monica, California USA
James L. Zazzali
Genentech, Inc., South San Francisco, California USA
Sandra Shields
Los Angeles County Department of Health Services, Emergency Medical Services Agency, Los Angeles, California USA
David P. Eisenman
RAND Corporation, Santa Monica, California USA Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California USA
Halla Alsabagh
Los Angeles County Department of Mental Health, Los Angeles, California USA
Senior Behavioral Scientist RAND Corporation 1776 Main Street Santa Monica, California 90407 USA E-mail:


Although information is available to guide hospitals and clinics on the medical aspects of disaster surge, there is little guidance on how to manage the expected surge of persons needing psychological assessment and response after a catastrophic event. This neglected area of disaster medicine is addressed by presenting a novel and practical quality improvement tool for hospitals and clinics to use in planning for and responding to the psychological consequences of catastrophic events that create a surge of psychological casualties presenting for health care. Industrial quality improvement processes, already widely adopted in the healthcare sector, translate well when applied to disaster medicine and public health preparedness. This paper describes the development of the tool, presents data on facility preparedness from 31 hospitals and clinics in Los Angeles County, and discusses how the tool can be used as a benchmark for targeting improvement. The tool can serve to increase facility awareness of which components of disaster preparedness and response must be addressed through hospitals' and clinics' existing quality improvement programs. It also can provide information for periodic assessment and evaluation of progress over time.

Research Article
Copyright © World Association for Disaster and Emergency Medicine 2010

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1. Galea, S, Ahern, J, Resnick, H, Kilpatrick, D, Bucuvalas, M, Gold, J, Vlahov, D: Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med 2002;346(13):982987.10.1056/NEJMsa013404CrossRefGoogle ScholarPubMed
2. Kawana, N, Ishimatsu, S, Kanda, K: Psycho-physiological effects of the terrorist sarin attack on the Tokyo subway system. Mil Med 2001;166(12Suppl):2326.10.1093/milmed/166.suppl_2.23CrossRefGoogle ScholarPubMed
3. Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E, Kaniasty, K: 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001. Psychiatry 2002;65(3):207239.CrossRefGoogle ScholarPubMed
4. Stein, BD, Tanielian, TL, Eisenman, DP, Keyser, DJ, Burnam, MA, Pincus, HA: Emotional and behavioral consequences of bioterrorism: Planning a public health response. Milbank Q 2004;82(3):413455.CrossRefGoogle ScholarPubMed
5. Berwick, DM: Continuous improvement as an ideal in health care. N Engl J Med 1989;320:5356.10.1056/NEJM198901053200110CrossRefGoogle ScholarPubMed
6. Berwick, DM, Blanton, G, Roessner, J: Curing Health Care: New Strategies for Quality Improvement in Health Care. San Francisco, CA: Jossey-Bass; 1990.Google Scholar
7. Cretin, S, Shortell, SM, Keeler, EB: An evaluation of collaborative interventions to improve chronic illness care: Framework and study design. Eval Rev 2004;28(1):2851.CrossRefGoogle ScholarPubMed
8.Agency for Healthcare Research and Quality: Translating research into practice (TRIP)-II. Fact sheet. AHRQ Publication No. 01-P017, 2001. Available at Scholar
9. Rubenstein, LV, Parker, LE, Meredith, LS: Understanding team-based quality improvement for depression in primary care. Health Serv Res 2002;37(4):10091029.10.1034/j.1600-0560.2002.63.xCrossRefGoogle ScholarPubMed
10. Parker, LE, de Pillis, E, Altschuler, A, Rubenstein, LV, Meredith, LS: Balancing participation and expertise: A comparison of locally and centrally managed health care Quality improvement within primary care practices. Qual Health Res 2007;17(9):12681279.10.1177/1049732307307447CrossRefGoogle ScholarPubMed
11. Meredith, LS, Mendel, P, Pearson, M, Wu, SY, Joyce, G, Straus, JB, Ryan, G, Keeler, E, Unützer, J: Success of implementation and maintenance of quality improvement for depression. Psychiatr Serv 2006;57:4855.10.1176/ Scholar
13. Seid, M, Lotstein, D, Williams, VL, Nelson, C, Lurie, N, Ricci, KA, Diamant, A, Wasserman, J, Stern, S: Quality Improvement: Implications for Public Health Preparedness. Santa Monica, CA: RAND Corporation; 2006.10.7249/TR316CrossRefGoogle Scholar
14. Mays, GP, Halverson, PK: Continuous Quality Improvement in Public Health Organizations. In: McLaughlin, CP, Kaluzny, AD, (eds.): Continuous Quality Improvement in Health Care: Theory, Implementation, and Applications. Boston: Jones and Bartlett; 2005:357406.Google Scholar
15. Lotstein, D, Ricci, KA, Stern, S, Li, J, Rubenstein, LV, Lurie, N: Enhancing Public Health Preparedness: Exercises, Exemplary Practices, and Lessons Learned, Phase III, Task B2: Final Report: Promoting Emergency Preparedness and Readiness for Pandemic Influenza (PREPARE for PI) Pilot Quality Improvement Learning Collaborative. 2007, Santa Monica, CA.Google Scholar
16. Meredith, LS, Eisenman, DP, Tanielian, T, et al: Prioritizing psychological consequences for disaster preparedness and response: A framework for addressing the emotional, behavioral, and cognitive effects of patient surge in large-scale emergencies. under review.Google Scholar
17. Donabedian, A: Evaluating the quality of medical care. Milbank Memorial Fund Quarterly 1966;44(Part 2):166206.10.2307/3348969CrossRefGoogle ScholarPubMed
18. Institute of Medicine: Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington, DC: The National Academies Press; 2003.Google Scholar
19. Meredith, LS, Eisenman, DP, Tanielian, T, Taylor, SL, Basurto, R: Preparing Hospitals and Clinics for the Psychological Consequences of a Terrorist Incident or Other Public Health Emergency and Preparing Los Angeles County Department of Mental Health Staff to Respond to Hospitals and Clinics Following Large-Scale Emergencies. Santa Monica, CA: RAND Corporation; 2007.Google Scholar