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Objective To establish a risk assessment model based infectious disease early warning system and promote the improvement of infectious disease management level.Methods By collecting and organizing the latest research results,and referring to the theoretical framework of the relevant infectious disease early warning evaluation index system,a risk assessment model based infectious disease early warning system is constructed.Results A total of 12 experts were included in this study,and three primary indicators were selected,including pre-epidemic indicators,typical symptom period indicators,atypical symp-tom period indicators,and 7 secondary indicators.The average score for necessity of the system was 8.27±0.24 points,and the average score for accessibility was 7.74±0.34 points.Conclusion The establishment of an infectious disease early warning sys-tem based on risk assessment models is conducive to timely following the epidemic trend of infectious diseases in the local area,analyzing the distribution trend of survey indicators,and proposing corresponding early warning plans,which can provide relevant basis for effective prevention of infectious diseases.
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Objective:To explore the effectiveness of the Shewhart control chart-based assessment and early warning system in prevention of medical device-related pressure injury(MDRPI).Methods:152 critically ill patients admitted to Hebei Central Hospital from January 2020 to December 2021 were selected and divided into a control group and an observation group based on different methods of assessing MDRPI risk,with 76 cases in each group.The control group adopted the Braden scale to assess the risk of MDRPI.The observation group adopted a safety early warning system based on Shewhart control charts to assess the risk of MDRPI in patients.Nursing measures were undertaken according to MDRPI risk grade in both groups.The occurrence of adverse events of MDRPI,nursing safety quality and nursing comprehensive quality were compared between the two groups.Results:The incidence rate of head,neck and face adverse events of MDRPI and the total incidence of adverse events of MDRPI of the patients in the observation group were lower than those in the control group(x2=4.802,5.758,P<0.05).The safety quality and comprehensive quality of nursing of 20 nurses in the observation group were higher than those in the control group(t=6.654,7.172,P<0.05).Conclusion:The application of assessment and early warning system based on Shewhart control chart in clinical nursing management can effectively reduce the incidence of MDRPI adverse events and improve the quality of nursing safety and comprehensive nursing.
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@#The coronavirus disease 2019 (COVID-19) pandemic has uncovered the need for health systems to be strengthened in order to be able to respond quickly to any potential future outbreaks. In response, the Pacific Syndromic Surveillance System (PSSS) is currently being used by many countries within the Pacific Islands for tracking and addressing infectious disease outbreaks, including COVID-19. To maximise its usefulness as an early warning system, investments must be made in strengthening data quality, data sharing, health facility capacity, technology, and ongoing evaluation of surveillance systems. Doing so will ensure that the PSSS and other surveillance systems can remain effective tools for monitoring and respond to infectious disease outbreaks in the Pacific Islands
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@#The neonatal mortality rate in Papua New Guinea is high, estimated at 24 per 1000 live births. The neonatal case fatality rate in newborns in provincial and referral hospitals was 5.9% in 2021. Deteriorating newborns can be difficult to identify. This observational study investigated the feasibility of using a neonatal colour coded observation and response chart to identify neonates at risk of deterioration and to promptly escalate care in the Special Care Nursery of Port Moresby General Hospital. The chart was adapted from the Plymouth Hospital Neonatal Early Warning System chart, and was used to collect data over 8 weeks between 1st May and 30th June 2022. One hundred and fifty seven (157) neonates were observed over the 72 hours following admission to the Special Care Nursery. Neonates were grouped into those that had triggers (vital signs that fell in the red zone) and a stable group (who had no observations in the red zone). Of the 157 patients recruited 72 (45.9%) were stable, and 85 (54.1%) had triggers that should prompt a response. Forty seven (55.3%) of the neonates in the trigger group had appropriate interventions. Neonates with observations in the red zone (triggers) were more likely to die in the first 72 hours compared with those with no triggers. Most of the nurse responded positively to the introduction of the chart. Whilst the Neonatal Early warning System is a tool that can be used to identify neonates at risk of clinical deterioration, proper training of its use and knowledge of and appropriate escalation of care are necessary to ensure its benefit
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Early warning of infectious disease outbreak is key to controlling epidemics. Public general hospitals can effectively play their " outpost" role in the early warning and response of infectious diseases, which is directly related to the success of epidemic prevention and control. The authors summarized the current construction and main functions of infectious disease early warning systems at national level, regional level and public general hospitals, analyzed the problems existing in such construction, and put forward targeted suggestions. As found by the authors, some public general hospitals in China have initially built an early warning system for infectious diseases, achieving early recognition, early warning and reporting of infectious diseases to some extent. However, these systems were challenged by such shortcomings as insufficient intelligence, lack of data information exchange, immature practice and application, and lack of attention to the monitoring and early warning of endemic infectious diseases. It is suggested to improve the policy and system support in the future, to expand the types of infectious diseases for monitoring and early warning, to enlarge the sources of monitoring data and to strength hospital informationization construction.
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Objective:To comprehensively evaluate and compare the early warning system's ability to predict the risk of maternal disease in China, such as the British National Intensive Care Audit and Research Center (ICNARC)-Obstetric Early Warning Score (OEWS) system, the National Maternal Safety Early Warning Standard (MEWC) recommended by the National Coalition for Maternal Safety, the Irish Maternity Early Warning System (IMEWS) proposed in the clinical practice guidelines issued by the head of health services at the Royal Medical College of Ireland.Methods:A total of 872 pregnant women who were admitted to the Women′s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital were prospectively observed from January 2019 to December 2019. The data during hospitalization were collected to calculate the scores of the three obstetric early warning scoring systems, to compare and evaluate the prediction and identification ability of three early warning systems for critically ill pregnant women.Results:A total of 872 cases were included in this study, of which 167 were critically ill, accounting for 19.2%, and 705 were non-critically ill, accounting for 80.8%. The three obstetric early warning systems (OEWS,MEWC,IMEWS) in critical group scored 4(2, 6),3(0, 6),5(3, 6), and non-critical group scored 1(0, 1), 0(0, 0), 2(0, 3), respectively. The critical group scored significantly higher than the non-critical group ( P<0.001). The AUC of OEWS was 0.961 (95% CI 0.948-0.975, P<0.001) and that of MEWC was 0.803 (95% CI 0.757 - 0.850, P<0.001). The AUC of IMEWS was 0.853 (95% CI 0.817-0.888, P<0.001). No obstetric critical illness occurred when OEWS was 0. The positive likelihood ratio was 8.208 6 when OEWS≥6. Conclusions:Three kinds of early warning systems have good predictive ability for the occurrence of critical obstetric diseases in China. Among the three warning systems, OEWS has better predictive ability than the other two, and has better hierarchical ability. However, due to the differences in population, environment and conditions in different regions, each obstetric medical unit can improve OEWS according to its own conditions and design an obstetric early warning system that meets its own clinical needs.
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【Objective】 To conduct accurate analysis of blood inventory, so as to provide basis for taking targeted measures. 【Methods】 Taking the suspended red blood cells(RBCs) as an example, mathematical formulas were set by online Excel table, and the inventory of each blood group of RBCs in a certain day can be predicted accurately by inputting daily inventory and units distributed, and estimated daily units collected.Preventive measures such as enhancing recruitment or limiting collection could be taken as soon as possible to keep the blood inventory at a reasonable level. 【Results】 Blood inventory had been moderate during the six months of practice, and neither blood shortage nor collected blood expiring occurred. 【Conclusion】 The early warning system based on the online form, which is highly practical and easy to operate, is suitable for inventory management of blood components.
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Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.
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Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29 201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.
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Objective To investigate the effect of pressure ulcer risk warning system in the pressure ulcer management in patients undergoing thoracolumbar fracture surgery.Methods A retrospective case control study was performed to analyze the clinical data of 120 patients with thoracolumbar fracture who underwent posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery at People's Hospital of Henan Province from October 2016 to September 2018.There were 76 males and 44 females,aged 45-80 years [(59.2 ± 7.2) years].A total of 60 patients received treatment and care under the pressure ulcer early warning system (early warning group),while 60 patients were given assessment form for pressure ulcer management (control group).The time of filling in the assessment form,the implementation score of pressure ulcer prevention measures,the incidence of pressure ulcer,visual analogue pain score (VAS) and patient satisfaction were compared between the two groups.Results In the control group and early warning group,the time of filling in the form was (121.5 ± 9.0) minutes and (11.3 ± 2.0) minutes (P ＜ 0.01),the implementation score of pressure ulcer prevention measures was (85.9 ± 3.8) points and (96.0 ± 2.2)points (P ＜ 0.01),and the pressure ulcer incidence was 25％ (15 patients) and 3％ (two patients),respectively (P ＜0.01).In the control group,the preoperative VAS was (7.3 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (3.7 ± 1.1) points,(3.2 ± 0.9) points,(2.4 ± 1.0) points,(2.3 ± 0.8) points,respectively.In the early warning group,the preoperative VAS was (7.4 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (2.9 ± 0.7) points,(2.4 ± 0.7) points,(1.8 ± 0.7) points,(1.6 ± 0.8) points,respectively.There was no significant difference in preoperative VAS between the two groups (P ＞ 0.05),while significant differences were found between the postoperative VAS (P ＜ 0.01).The satisfaction score in the control group was (94.6 ± 1.4) points,while that of the early warning group was (98.3 ± 1.1) points (P ＜ 0.01).Conclusion For patients undergoing posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery,the pressure ulcer risk warning system is convenient and reduces the incidence of pressure ulcer,thus alleviating patients'pain and improving patients' satisfaction.
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Objective@#To analyze the effectiveness and response status of China Infectious Disease Automated Alert and Response System (CIDARS) in Hunan province from 2012 to 2016 for improving the system.@*Methods@#To collect the early warning signals, the number of suspected events, the result of on-site investigation, the signal response time and the result of public health emergencies, and the χ2 test, correlation analysis and non-parametric test were used to analyze the information on CIDARS in Hunan Province during the period from 2012 to 2016.@*Results@#A total of 108 188 signals were generated by the CIDARS in Hunan Province; The warning involved 30 kinds of infectious diseases and 138 counties (districts), and each county (district) received 3.00 weekly warning messages on average; 100% early warning signal was responded, 2 h response rate was 92.43%; The median response time (P25-P75) was 0.28 (0.11-0.77) h in the single case warning, and the five-year timely response rate showed an upward trend year by year (trend χ2=58.89, P<0.05); the median response time (P25-P75) was 0.56 (0.28~1.06) h in the time series warning, and the five-year timely response rate showed no trend (trend χ2=2.43, P>0.05); the time series warning response was more timely than the single case warning, and the difference between the two timely response rates was statistically significant(χ2=5156.60, P<0.05). The studies showed that the sensitivity, specificity, and detection timeliness of the system were 84.80%, 69.53%, and 2.80 d, respectively; There was no significant difference in the infectious diseases detecting timeliness of CIDARS(H=8.75, P>0.05); the system had the best effect in rubella, and the positive likelihood ratio of rubella is 4.36.@*Conclusions@#CIDARS in Hunan province runs well overall with high sensitivity and timely response to the early warning signals, but the specificity of the early warning system needs to be improved. The quality of the epidemic report of infectious diseases needs to be further improved, and the early warning parameters and warning method should be adjusted according to the characteristics of different diseases and the differences among different regions.
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Objective@#To analyze the effectiveness and response status of China Infectious Disease Automated Alert and Response System (CIDARS) in Hunan province from 2012 to 2016 for improving the system.@*Methods@#To collect the early warning signals, the number of suspected events, the result of on-site investigation, the signal response time and the result of public health emergencies, and the χ2 test, correlation analysis and non-parametric test were used to analyze the information on CIDARS in Hunan Province during the period from 2012 to 2016.@*Results@#A total of 108 188 signals were generated by the CIDARS in Hunan Province; The warning involved 30 kinds of infectious diseases and 138 counties (districts), and each county (district) received 3.00 weekly warning messages on average; 100% early warning signal was responded, 2 h response rate was 92.43%; The median response time (P25-P75) was 0.28 (0.11-0.77) h in the single case warning, and the five-year timely response rate showed an upward trend year by year (trend χ2=58.89, P<0.05); the median response time (P25-P75) was 0.56 (0.28~1.06) h in the time series warning, and the five-year timely response rate showed no trend (trend χ2=2.43, P>0.05); the time series warning response was more timely than the single case warning, and the difference between the two timely response rates was statistically significant(χ2=5156.60, P<0.05). The studies showed that the sensitivity, specificity, and detection timeliness of the system were 84.80%, 69.53%, and 2.80 d, respectively; There was no significant difference in the infectious diseases detecting timeliness of CIDARS(H=8.75, P>0.05); the system had the best effect in rubella, and the positive likelihood ratio of rubella is 4.36.@*Conclusions@#CIDARS in Hunan province runs well overall with high sensitivity and timely response to the early warning signals, but the specificity of the early warning system needs to be improved. The quality of the epidemic report of infectious diseases needs to be further improved, and the early warning parameters and warning method should be adjusted according to the characteristics of different diseases and the differences among different regions.
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Objective To explore the value of intelligent early warning system in pre- and in-hospital connection in the treatment of stroke. Methods The clinical data of the patients with suspected stroke, who received treatment and prehospital warning with intelligent early warning system in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Nov. 2017 and Jun. 2018, were retrospectively analyzed. Pre-hospital warning was defined as 120 alerting stroke teams using software before transferring patients to the target hospital. According to the in-hospital treatment methods, the patients were divided into non-stroke group, conservative treatment group, thrombolysis group, thrombectomy group, bridging group and cerebral hemorrhage group. The efficiency in each link of the intelligent early warning system, the ability of emergency doctor diagnosing stroke, the ability of emergency doctor diagnosing severe stroke using gaze-face arm speech time (G-FAST) scale, the speed of first aid response of the attending physician and the door-in-to-door-out (DIDO) time in primary stroke center were evaluated in each group. Results A total of 248 patients were included in this study, including 24 non-stroke patients and 224 stroke patients (101 patients in the conservative treatment group, 23 patients in the thrombolysis group, 32 patients in the thrombectomy group, 22 patients in the bridging group and 46 patients in the cerebral hemorrhage group). The median primary screening time, early warning time and response time of 248 patients were 28.0 (13.0, 92.5), 11.0 (7.3, 15.3) and 19.0 (13.0, 35.0) s, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 6 pre-hospital emergency physicians diagnosing severe stroke using G-FAST scale were 84%, 71%, 83%, 72% and 79%, respectively. Eight patients with severe stroke underwent whole-process monitoring of pre-hospital treatment, and had a median transport time of 113 (82, 142) min and a median DIDO time of 84 (12, 125) min. Conclusion Intelligent early warning system can realize the automation of data acquisition for transfer time points, making the data more comprehensive and reliable. It is helpful to analyze the efficiency of emergency physicians, drivers, stroke teams and primary stroke center in pre- and in-hospital connection in the treatment of stroke, so as to shorten the pre-hospital treatment time and improve the pre-hospital treatment efficiency.
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Studies have shown that pregnant women due to their specificity and social factors during pregnancy, maternal mortality and postpartum serious complications were significantly higher. Taking effective measures to control maternal mortality and ensuring the safety of pregnant women is an urgent problem to be solved.The first measure to ensure the safety of pregnant women is to use appropriate assessment tools, accurate, dynamic and comprehensive risk assessment of pregnant women. At present, with the start of a comprehensive two-child policy,research related to obstetric early warning scores has become the focus of research in the field of obstetric care.Therefore,this article through the"obstetrics","maternal","risk warning","risk score"as the key word,search Wanfang database,Chinese Journal full-text database(CNKI),Chinese biomedical literature database(CBM);foreign language literature,such as PubMed,Web of Science,Springer,EBSCO and other databases,with"early warning score","risk score","risk score system","Obstetric","Obstetric care"Word for retrieval.So that to provide a comprehensive analysis of the status quo of the use of early risk assessment tools at home and abroad,and to summarize the contents of the assessment tools,and further point out the problems in the current research.
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Mass gatherings pose public health challenges to host countries, as they can cause or exacerbate disease outbreaks within the host location or elsewhere. In July 2012, the 11th Festival of Pacific Arts (FOPA), a mass gathering event involving 22 Pacific island states and territories, was hosted by Solomon Islands. An enhanced syndromic surveillance (ESS) system was implemented for the event. Throughout the capital city, Honiara, 15 sentinel sites were established and successfully took part in the ESS system, which commenced one week before the FOPA (25 June) and concluded eight days after the event (22 July). The ESS involved expanding on the existing syndromic surveillance parameters: from one to 15 sentinel sites, from four to eight syndromes, from aggregated to case-based reporting and from weekly to daily reporting. A web-based system was developed to enable data entry, data storage and data analysis. Towards the end of the ESS period, a focus group discussion and series of key informant interviews were conducted. The ESS was considered a success and played an important role in the early detection of possible outbreaks. For the period of the ESS, 1668 patients with syndrome presentations were received across the 15 sentinel sites. There were no major events of public health significance. Several lessons were learnt that are relevant to ESS in mass gathering scenarios, including the importance of having adequate lead in time for engagement and preparation to ensure appropriate policy and institutional frameworks are put in place.
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OBJECTIVE:To improve the level of rational drug use,and to reduce the workload of clinical pharmacists. METH-ODS:Established“Intelligent Management and Solution for Clinical Rational Drug Use”of our hospital was introduced,including post-prescription review(all prescriptions review)system, self-maintenance system for rational drug use knowledge base,pre-pre-scription review (rational drug use real-time review) early warning system. The effects of intelligent system were evaluated. RE-SULTS & CONCLUSIONS:After the application of the system,the following aspects could be achieved,including“all prescrip-tions review”,“multi-prescriptions/longitudinal review”,system knowledge base real-time update and autonomous definition of re-view rules,effective communication and intervention between physicians and pharmacists before printing prescription by Yaozhidao instant messaging system. Through related trial evaluation,the proportion of false positive prescriptions decreased by 17.65% after 4 months of the application of the system;drug consultation prescriptions review average score of outpatient pharmacists increased from 81 to 94.85;the time of prescription review decreased by 4.72-5.46 times. Through mandatory interception of unqualified pre-scriptions,severe warning,timely prompt and pharmacists’intervention,the rate of unqualified prescriptions pre-reviewed by the system in respiration department decreased from 32% in Jan. 2015 and 21% in May to 4.62% in Dec. So,the application of the system promotes rational drug use in outpatient department,reduces the workload of pharmacists and ensures the safety of drug use comprehensively.
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Chinese materia medica (CMM) and pieces of Chinese medicine are important composition of National Essential Drugs List, which also embodys the characteristics of traditional Chinese medicine (TCM). National Essential Drugs List is well known for its "safe, necessary, effective, inexpensive", but some chemicals in the list are often short of supply because of their low cost. Usually, Chinese patent medicine composes of more ingredients in prescription, among which there is a complementary price and the price fluctuation is in the normal range. But in recent years, some CMM prices experience massive run-ups followed by precipitous falls, which results in medicine manufacturers stopping production. The effect of short-term rising on feed quality can not be ignored. This article discusses the necessity and feasibility of early warning methods for the essential Chinese medicine supply based on National Census of CMM Resource Survey, and this method is explained and demonstrated with Compound Danshen Tablets as example.
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Objective To evaluate the effect of automatic early warning information system on the response of malaria elimi-nation in Jiangsu Province through the operation of the national automatic early warning system of infectious diseases. Methods The malaria early warning information was collected from the automatic early warning information subsystem in the national infor-mation system for diseases control and prevention. Malaria early warning signals were analyzed from September 1 to December 31, 2012. The statistical analysis was conducted for the completion rates of case investigation within 3 days before and after the applica-tion of malaria early warning information system. Results Jiangsu Province received 85 mobile phone short messages(SMS)of malaria case from early warning system from September 1 to December 31,2012. After judgments,23 cases were deleted includ-ing 8 repeated cases and 15 cases that were excluded through the microscopy examination and epidemiological investigation by the confirmation of county CDC. From July to December in 2012,the monthly completion rates of case investigation within 3 days were 55.56%,78.57%,90.00%,100%,100%and 100%,respectively. The completion rates of case investigation within 3 days in Ju-ly,August,September and October were significantly different by χ2 test(χ2=10.66,P<0.05). The completion rates of foci in-vestigation and action within 7 days in Jiangsu Province were all 100%from July to December in 2012. Conclusions The comple-tion rates of case investigation within 3 days are associated with SMS from the early warning system. The malaria warning system from the national infectious diseases can effectively improve the response to malaria cases for primary CDC. It also plays an impor-tant role for the timely confirmation and diagnosis of malaria cases.
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Objective To explore the reporting process of our health risk warning system and its long-term effectiveness.Methods A total of 1 168 individuals who were identified as higher risk populations from July 2011 to June 2012 in our Health Mangement Center were served as the control group,and another 973 adults who were identified as higher risk individuals from July 2012 to May 2013 were assigned to the study group.Diagnosis and treatment were based on our health risk reporting process and follow-up system.Paired t test and paired contingency table x2 test were used for data analysis.Results The rate of follow-up (97％ vs 100％,x2=30.503,P＜0.05),consultation (83.48％ vs 93.63％,x2=52.142,P＜ 0.05),mean treatment time ((3.0±0.5) vs (1.5±0.5) d,t=69.12,P＜0.05) and patient satisfaction (87.84％ vs 96.20％,x2=48.361,P＜0.05) were significantly different between the two groups,although no statistically significant difference of incidence of adverse events was found (0.26％ vs 0.10％,x2 =0.102,P＞0.05).Conclusion Our health risk warning system may reduce the time for physical examination and improve disease diagnosis level and patients' satisfaction.Moreover,our health manatement system and health service quality should further be improved in practice.
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Objective: Through the application of the financial early warning system based on sustainable growth, prevent financial risks and promote the sustainable development of the hospital. Methods:Correct single variable early warning model, add the sustainable growth rate index and build up financial early warning system based on sustainable growth. Results: New financial early warning system could make judgement on the potential financial risk in hospital and the early warning effect is good. Conclusion: The new financial early warning system provides identification method of intuitive financial risk for hospital managers, the financial risk of the hospital sustainable development could provide advance warning to avoid further crisis.