title: Relationship between standards of procedures for pandemic flu and level of hospital performance in simulated drills.
abstract: OBJECTIVE
  Standard operating procedures are the basis of a consistent response to varied threats. The aim of this study is to investigate the relationship between the quality of standard operating procedures developed by hospitals for the management of a pandemic influenza outbreak and the level of performance in a H5N1 flu drill.
  
  
  METHODS
  Standard operating procedures developed by all general hospitals in Israel for the management of pandemic influenza were evaluated with a tool developed for this purpose. The hospital standard operating procedure score was then compared with the score obtained by the hospital in a simulated drill.
  
  
  RESULTS
  Cronbach's alpha was used to determine the reliability of the standard operating procedure evaluation scores and the scores obtained on the drill. Reliability of both scores was high (>0.70). Hospital standard operating procedure scores were found to be moderately related to the scores obtained on the simulated drill. An important relationship was found between performance on the drill and the following components of the standard operating procedure: protection of staff and patients, staffing coordination and control, and infrastructure maintenance and minimizing overload. Hospital characteristics were not found to be important in determining either the hospital standard operating procedure score or performance on the simulated drill.
  
  
  CONCLUSIONS
  A reasonably strong relationship was found between quality of the standard operating procedures developed by hospitals to deal with a pandemic influenza and performance on a pandemic drill. Components of the standard operating procedure that dealt with areas that were relatively unfamiliar to staff or topics that were perceived by personnel as posing a risk to their well-being were found to be more important. The quality of the standard operating procedures was found to be important in relation to performance in a pandemic flu drill; therefore, we suggest investing effort in developing standard operating procedures that are comprehensive and cover relatively new domains in detail.
authors.affiliation: Emergency and Disaster Management Division, Ministry of Health, Tel-Aviv, Israel.
authors.forename: Bruria
authors.initials: B
authors.lastname: Adini
authors.forename: Avishay
authors.initials: A
authors.lastname: Goldberg
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-Dayan
mesh_terms: D004190:Disasters; D004196:Disease Outbreaks; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D007557:Israel / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results