Part II Tracing for Success
In PART I, we discussed the pre-planning activities needed when addressing Emergency Operations. When your review is complete and you are satisfied that your Emergency Operations Plan is effective, meets regulatory requirements and more, trace your process using this guide adapted from: Falcone, RE. et al. “The Next Pandemic: Hospital management” December 2015, Relias Media.
1) Has there been a Critical Care triage framework implemented that includes:
- Identification of patients who will require higher-level care at some stage
- Identification of the number of ICU beds, Critical Care beds, ventilators, staff trained to operate ventilators and medications needed for ventilator care
- Recognition of patients who are too unwell to benefit from critical care
- Be consistently applicable by health care workers and professionals from diverse backgrounds and scalable to reflect varying levels of need and capacity and
- Protocols for re-assessment of triaged patients to determine if they are declining (chest wounds, trauma, infectious disease, etc.)
2) Has preparation been completed to ensure that hospitals are equipped, in terms of organization, staffing, resources, assets and supplies:
- Employment of a full-time incident coordinator (may be based on size, location and HVA)
- Use of a preparedness committee with clinical, support, and senior administrative representation
- Participation in a regional hospital coordinating group, with mutual aid agreements
- Use of FluSurge and HHS planning assumptions to guide planning for moderate and severe pandemics
- Ability to make 30% of licensed bed capacity available for flu patients within 1 week and
- Collaboration in regional plans to make 200% of licensed bed capacity available for flu within 2 weeks
3) Have screening processes, staging, and screening locations, drive-up services, home service, telehealth services been developed?
4) Is there an effective Staff Education and Training Program, that includes?
- Recommended infection control precautions, including contact and droplet precautions
- Reporting requirements (i.e. influenza) to hospital and public health officials
- Planning strategies for nosocomial surveillance
- Proper use of PPE and hand hygiene
- Provision of respiratory etiquette educational materials – for staff, patients, and visitors
- Training of infection control monitors
- All hazard information (utility failures, mass casualty to disease outbreaks) and
- Drills including “tabletop” simulation exercises
5) Are there adequate amounts of equipment and supply caches: given that supply is likely to be limited in a pandemic, even taking the Strategic National Stockpile (SNS) into account, hospitals may also wish to create their own caches of supplies and medication. It has been estimated that the cost of preparedness for the average 164-bed hospital is $1,000,000 ($200,000 for a pandemic plan, $160,000 for staff education and training, $400,000 for stockpiling minimal personal protective equipment [PPE], and $240,000 for stockpiling basic supplies).
6) Is there a plan for staffing during an emergency response (i.e. pandemic): making the most of a limited workforce?
- Rapid testing for staff available 24/7, with initiation of antiviral treatment within six hours of symptom onset
- Providing in-home childcare for well children using screened volunteers
- Offering medical daycare to sick family members
- Open, honest, and transparent planning
- Transitioning clinical staff to high-need areas
- Bolstering clinical staff with nontraditional personnel and
- Coordinating with other hospitals on recruiting and using volunteers
- In addition to volunteers, medical students, nursing students, and retired or out-of-state health care workers may be used to reinforce hospital staffing
- Staffing plans, work assignments, layoffs, furloughs, cancelling elective services.
7) Are there adequate supplies of Personal Protective Equipment: during the SARS outbreak of 2003, one 1300-bed hospital reported daily PPE use during the peak: 3000 disposable isolation gowns, 14,000 pairs of gloves, 18,000 N95 respirator masks, 9500 ear loop masks, and 500 pairs of goggles.
8) Is there a program for the Psychological Effects on the Health Care Worker and Community: Data on the psychological effects of a pandemic are limited, but experience with natural disasters suggests that stress reactions could be common, and human service workers may have a high risk of post-traumatic stress disorder.
9) Has there been a plan for Mortuary Operations: surge of patients and increase in mortality will overwhelm the organizations ability to process, care for and provide proper storage for bodies?
The United States and all Healthcare organizations must heed the Covid-19 outbreak and apply lessons learned after the National response is fully evaluated. As High Reliable Organizations, we all need to share and learn from this response. We need to plan to be prepared. We need to ensure that plans are flexible enough to adjust to the situation, but still be effective. We need to utilize the current resources to ensure that our supply and equipment needs can be met in a timely manner. We need to tap into the Public Health Emergency Preparedness (PHEP) cooperative agreement which allocates roughly $620,250,000 a year for States and highly populated areas to prepare for emergencies. We need an All Agency organized system to prevent the US stockpiles from being quickly depleted and supply chains from becoming bogged down.
The result of learning and sharing from the Covid-19 response will be: 1) We will have adequate supplies and protective gear for our healthcare workers, 2) We will have adequate screening capabilities for our populations and 3) We will protect people’s lives as best as possible when responding to the next emergency situation.
Join us next month for this continuing series to learn a futuristic approach for incorporating High Reliability principles into our Emergency Preparedness Plans.
Mass Casualty Trauma Triage – Paradigms and Pitfalls (July 2019) – ASPR TRACIE whitepaper
CMS 482.15 Emergency Preparedness Condition of Participation (2/2020)
Joint Commission Hospital Accreditation Manual 2020 – Chapter Emergency Management
The Next Pandemic: Hospital Management (Falcone, R et al); Last published 2015, Relias Media https://www.reliasmedia.com/articles/136827-the-next-pandemic-hospital-management
Preparing intensive care for the next pandemic influenza (Kain, T and Fowler, R) ( 2019); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819413/
How hospitals can prepare for an influenza pandemic (Masterson, L) (2017) – Healthcare Dive
Centers for Disease Control and Prevention (CDC) Pandemic Planning
World Health Organization (WHO) Pandemic Planning