title: [Impact assessment of inadequate hospital disaster management : Reflection based on a risk model].
abstract: BACKGROUND
  According to legal regulations alarm and emergency plans have to be developed and kept current in hospitals. However, often neither the hospital administration, nor the medical employees and nursing staff pay the necessary attention to these alarm and evacuation plans. In particular, risks and consequences - including financial ones - due to insufficient planning, are not adequately considered.
  
  
  OBJECTIVE
  Risks in hospitals are assessed based on a risk analysis. The risk assessment evaluates, whether the risk is acceptable, critical or unacceptable. Parameters for the risk analysis are the magnitude of damage and number of affected people. The intention of this paper is to evaluate whether there is a connection between estimated risk, quality of risk planning, and financial damage.
  
  
  METHODS
  We visualized the risk analysis as a two-dimensional matrix. In addition, we introduced disaster planning quality as a third dimension and calculated the dependency between risk and planning quality and also between the resulting damage level and the planning quality.
  
  
  RESULTS
  We showed that a poor disaster planning quality increases the unacceptable risk exponentially. Risk assessment can also draw conclusions about the extent of financial damage caused, for example fires, terrorist attacks or infrastructure failure. The amount of damage can be described as a function depending on the planning deficit of emergency planning. The worse the planning quality, the higher the amount of damages for non-tolerable risks can be.
  
  
  CONCLUSIONS
  Risk management means recognizing risks, assessing risks and managing risks. In hospitals, this mostly means using a critical incident reporting system (CIRS), however risk management in the sense of disaster planning is largely unknown. With a three-dimensional risk matrix, we showed a clear correlation between the quality of disaster planning and relative risk or financial damage. To substantiate the presented theoretical considerations, however, further research must be designed and implemented.
authors.affiliation: Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland. ernst.pfenninger@uniklinik-ulm.de.
authors.forename: E
authors.initials: E
authors.lastname: Pfenninger
authors.affiliation: Chirurgischer Zentral-OP, Universitätsklinikum Ulm, Ulm, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Güzelel
mesh_terms: D003362:Cost-Benefit Analysis; D004189:Disaster Planning / Q000191:economics / Q000379:methods*; D004190:Disasters; D004469:Economics, Hospital; D006739:Hospital Administration; D006801:Humans; D012308:Risk Management / Q000191:economics / Q000379:methods*; D023481:Terrorism
keywords: Cost-benefit analysis; Disaster management; Hospital; Preparedness; Risk management