Best practices for after-action review: turning lessons observed into lessons learned for preparedness policy

Sustaining Preparedness in Hospitals

PURPOSE

The years following the 9/11/2001 terrorists attacks saw a marked increase in community and hospital emergency preparedness, from communications across community networks, development of policies and procedures, to attainment and training in the use of biological warfare resources. Regular drills ensured emergency and health care personnel were trained and prepared to address the next large-scale crisis, especially from terrorist and bioterrorist attacks. This chapter looks at some of the more familiar global health issues over the past two decades and the lessons learned from hospital responses to inform hospital management in preparation for future incidents.

SEARCH METHODS

This study is a narrative review of the literature related to lessons learned from four major events in the time period from 2002 to 2023 - SARS, MERS, Ebola, and COVID-19.

SEARCH RESULTS

The initial search yielded 25,913 articles; 57 articles were selected for inclusion in the study.

DISCUSSION AND CONCLUSIONS

Comparison of key issues and lessons learned among the four major events described in this article - SARS, MERS, Ebola, and COVID-19 - highlight that several lessons are "relearned" with each event. Other key issues, such as supply shortages, staffing availability, and hospital capacity to simultaneously provide care to noninfectious patients came to the forefront during the COVID-19 pandemic. A primary, ongoing concern for hospitals is how to maintain their preparedness given competing priorities, resources, and staff time. This concern remains post-COVID-19.

Assessing public health preparedness and response in the European Union- a review of regional simulation exercises and after action reviews

BACKGROUND

Improving response capacities in the EU requires a good overview of capacities at both country and Union level. The International Health Regulations (2005) Monitoring and Evaluation framework assesses capacities in countries. It includes semi-quantitative tools such as State Parties Annual Report (SPAR) and Joint External Evaluation (JEE). After Action Reviews (AAR) and Simulation Exercises (SimEx) were included to identify weaknesses in the functionality of capacities which are not addressed bySPAR and JEE. This study presents an analysis of the use of qualitative tools at regional level, in Europe. It aims to identify their added value by comparing them to standardised monitoring tools and lessons learned from COVID-19, and considers ways to improve their use in assessing capacities in the EU.

METHODS

We included 17 SimEx and 2 AAR organised by the European Commission between 2005 and 2018. We categorised a total of 357 recommendations according to the IHR (2005) core capacities and to the target audience of the recommendation. We analysed the data using language analysis software. Recommendations to countries were compared to SPAR and JEE indicators. Recommendations to EU agencies were compared to the current mandates of the EU agencies, and to lessons learnt during COVID-19.

RESULTS

Of all extracted recommendations from the exercises, 59% (211/357) targeted EU agencies, 18% (64/357) targeted countries, and 16% (57/357) targeted both. Recommendations mainly addressed areas of IHR coordination (C2), heath emergency management (C7) and risk communication (C10), and not low scoring areas. Recommendations complement SPAR indicators by identifying gaps in functionality. Eight out of ten early lessons learnt during the COVID-19 pandemic had been raised earlier as recommendations from exercises. Exercise reports did not include or result in action plans for implementation, but COVID-19 has accelerated implementation of some recommendations.

CONCLUSION

SimEx/AAR provide valuable insight into public health preparedness at EU level, as they assess functionality of preparedness and response mechanisms, point out gaps, and provide training and awareness on for participants, who often have key roles in public health emergencies. Better follow-up and implementation of recommendations is key to improve the regional preparedness for international public health incidents such as pandemics.

Rising through the pandemic: a scoping review of quality improvement in public health during the COVID-19 pandemic

Background

The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear.

Methods

We conducted a scoping review of literature published January 2020 – February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted using four bibliographic databases, in addition to a supplementary grey literature search through custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review.

Results

Records were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators.

Conclusions

The literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization’s management philosophy and culture, as well as project level activities at all stages of the emergency management cycle.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12631-0.

COVID-19 Pandemic Surge: After-Action Report of a Coalition of Emergency Departments in New York City

The coronavirus disease (COVID-19) pandemic has stressed the US health care system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here, we present a structured after-action report of a coalition of 9 EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth. We report our experience in 6 key areas using a framework built around lessons learned. This report represents the most salient concepts related to our institutional after-action report, and those seemingly most relevant to our peer institutions dealing with similar circumstances.