The KAEPacity Study Analyzes Hospital Emergency and Disaster Plans From Hospitals Across Germany to Evaluate How Well Hospitals Are Prepared for Crises and Disasters Organizational Structures Communication Leadership Training Are Examined Within These Plans No Medical Intervention is Performed

KAEPacity is an observational, mixed-methods, descriptive-comparative document analysis of Hospital Emergency and Disaster Plans (Krankenhausalarm- und -einsatzpläne; KAEP) from hospitals in Germany. The aim is to characterize and compare how hospitals operationalize preparedness for exceptional events (e.g., mass casualty incidents, technical failures, security incidents, pandemics) through their written emergency planning documents, and to derive evidence-informed recommendations for quality improvement and harmonization.

Participating hospitals provide their current KAEP documents (and, if available, related materials such as exercise plans, training concepts, evaluation reports, and "lessons learned" documentation). All received documents are stored in a secure institutional environment and processed confidentially. Prior to analysis, documents are pseudonymized: identifying information about hospitals and individuals is removed as far as feasible, and each hospital is assigned a study code (e.g., KH01). Hospital-level characteristics relevant for comparative analyses (e.g., care level, size category, ownership/management type, region) are recorded in a separate, access-restricted key file and used only for aggregated comparisons.

The analysis is conducted using a structured criteria framework derived from national guidance (including the BBK KAEP handbook) and international recommendations (including the WHO Hospital Emergency Response Checklist), complemented by findings from current hospital preparedness and disaster medicine literature. The framework covers core preparedness domains such as: plan structure and governance, leadership and command arrangements, alerting and activation processes, triage concepts and patient flow organization, internal and external communication pathways, defined hazard scenarios and functional annexes, and training, exercises, evaluation, and plan maintenance.

Qualitative analysis follows a deductive-inductive content analytic approach: an initial codebook is developed from guidelines and established models, and then iteratively refined by adding inductive subcategories when additional recurring themes or organizational patterns emerge from the material. In addition to explicit content, the analysis considers aspects such as role logic, implied assumptions, handling of uncertainty, and indications of preparedness culture as reflected in the documents' structure and language.

To support comparability across hospitals, selected structural and process features are additionally rated on an ordinal 0-5 scale (0 = not present; 1 = insufficient; 2 = partially present; 3 = adequate; 4 = well developed; 5 = fully operationalized). This allows descriptive summaries and stratified comparisons across hospital categories without identifying individual institutions. Where feasible, interrater reliability procedures are implemented (e.g., double-coding of a subset and consensus review) to increase the robustness of coding and ratings.

The study does not involve patient recruitment, clinical interventions, or collection of personal health data. Results will be reported exclusively in aggregated form to prevent identification of individual hospitals. The primary intent is to generate an evidence base on current KAEP practice in Germany and to highlight best-practice elements and development needs that can inform future preparedness guidance, training, and quality assurance initiatives.

Inclusion criteria

German hospitals with a documented KAEP Institutional consent to provide KAEP documents for analysis

Exclusion criteria

Hospitals declining participation Specialized facilities without emergency or acute care services (e.g., rehabilitation clinics)