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Business Readiness and Response Plan for COVID-19€¦ · enacting overflow as per the Pandemic...
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CHQ COVID-19 Readiness and Response Plan August 2020
Table of Contents
Introduction ....................................................................................................................................................................................... 1
Purpose ................................................................................................................................................................................... 1
Scope and key objectives ......................................................................................................................................................... 1
Roles and responsibilities .................................................................................................................................................................. 2
Authority and activation ............................................................................................................................................................ 2
Overview of statewide tier 0-5 approach ............................................................................................................................................ 2
Working together to support statewide access to paediatric care ........................................................................................................ 3
Our readiness and response approach .............................................................................................................................................. 4
Response through our established services .............................................................................................................................. 5
Surge capacity response during COVID-19 pandemic ............................................................................................................... 6
Statewide considerations .......................................................................................................................................................... 7
Review and evaluation ...................................................................................................................................................................... 8
Key supporting documents ................................................................................................................................................................ 8
Appendix 1 Tier 0 Prevent local transmission and prepare ......................................................................................................... 10
Appendix 2 Tier 1 Limited community transmission .................................................................................................................... 12
Appendix 3 Tier 2 Moderate community transmission ................................................................................................................. 14
Appendix 4 Tier 3-5 Significant community transmission ............................................................................................................ 15
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Introduction
Purpose
The following plan provides a strategic overview of Children’s Health Queensland’s (CHQ) evolving planning and response to the global
pandemic, novel coronavirus (COVID-19). The plan articulates the approach and tactics which will be triggered to support Metro-Brisbane and
statewide access to paediatric healthcare services.
The current context is complex and ever-changing. Given this, the CHQ COVID-19 Readiness and Response Plan will remain a live document
which will be reviewed and updated in response to new information and changes within the environment.
Scope and key objectives
The CHQ COVID-19 Readiness and Response Plan has been established in a complex planning environment and inter-relates to many
internal and external plans at a local, state-wide and national level (see document list).
Overall, this plan functions as a key decision-making tool for CHQ’s Divisional and Executive Leadership Team (DDELT) and provides
overarching information to support and align localised surge and disruption plans across all CHQ divisions, services and corporate functions.
It has been developed in the context of the Queensland Health Pandemic Influenza Plan, Australian Health Management Plan for Pandemic
Influenza and Australian Health Sector Emergency Response plan for Novel Coronavirus (COVID-19) and should be utilised alongside CHQ’s
Code Brown (External Emergency) disaster management plan.
Key objectives of the CHQ COVID-19 Readiness and Response Plan include:
• Provide overarching visibility of state-wide tiered approach that guides CHQ’s response to increasing demand, associated capacity,
staffing and resourcing challenges whilst maintaining safe infection control measures before, during and after the COVID-19 event.
• Articulate the process and likely thresholds for escalation and de-escalation between tiers 0-5.
• Outline CHQ’s COVID-19 pandemic plan in relation to both the state and national respiratory pandemic management plans.
• Provide an effective health response framework to contain and control the disease as well as reduce morbidity and mortality associated
with COVID-19.
• Provide alignment to relevant policies, procedures and work instructions that support implementation of a functional organisational
response to COVID-19, including management of large influxes of paediatric patients with respiratory or transmissible viral illness (and
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their families), requiring a surge in health service response which may include the provision of mass vaccination and influenza like
illness (ILI), novel organisms assessment and fever clinics.
Roles and responsibilities
Authority and activation
On 29 January 2020 the Minister for Health and Minister for Ambulance Services made an order declaring a public health emergency relating to
coronavirus disease (COVID-19) under the Public Health Act 2005 (Qld). During a public health emergency, the Chief Health Officer can issue
Public Health Directions to assist in containing, or to responding to, the spread of COVID-19 within the community. On 17 August 2020,
Queensland’s declared public health emergency for COVID-19 was extended to 11.59 pm on Friday 2 October 2020.
Activation of the CHQ COVID-19 Readiness and Response Plan is authorised by the CHQ Health Service Chief Executive (HSCE), Executive
Director Clinical Services (EDCS), the Executive Director Clinical Services, Queensland Children’s Hospital (EDCS-QCH) or their nominated
delegate, under the following conditions:
• Activation of the Queensland Health Pandemic Influenza Plan; or a Declaration of a State of Emergency due to an outbreak that
constitutes a Public Health Emergency in accordance with the Public Health Act 2005 and the Queensland Health Disaster and
Emergency Incident Plan.
• Potential or actual threat of a transmissible virus and/or seasonal influenza or another transmissible respiratory infection with the ability
to overwhelm CHQ service capacity.
When activating the plan, the HSCE, EDCS-QCH, EDCS or delegate will determine the appropriate tier of response activation. If required, the
Health Emergency Operations Centre (HEOC) procedure is enacted.
Once activated, the command and control arrangements will be implemented in accordance with the CHQ Managing organisational disruption
policy. In addition to roles outlined in the HEOC procedure, collaboration with Infectious Disease and Infection Management and Prevention
Service will be required. Other key stakeholders may be called upon to provide expert advice to the HEOC team.
Overview of statewide tier 0-5 approach
CHQ has aligned its COVID-19 planning to the Framework for the tiered Queensland Health response to COVID-19 (tier 0-5). CHQ will respond
based on the planning and preparedness activities in place and will appropriately move between tiers in line with the current external and
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internal demands on services. This process will be governed and supported by business as usual disaster management processes including
the Health Emergency Operations Centre (HEOC).
Overarching and aligned tier response plans can be found in appendices 1-4. All phases of the response are supported by the Infection Control
Guidelines for the Management of Coronavirus and key strategies identified by the Case Management and Infection Prevention and Control
workstream.
Working together to support statewide access to paediatric care
CHQ performs a critical role in maintaining access to paediatric services while supporting state-wide capacity surges. To support children,
young people and their families across the state, CHQ will apply the below core principles to support access to care.
TIER 0 / TIER 1
Prevent local transmission and
prepare/Limited community transmission
TIER 2
Moderate community
transmission
TIER 3 – 5
Significant community
transmission
Recover and
regenerate
CORE PRINCIPLES
• Support safe paediatric care as close to home as possible
• Recognise statewide staff wellbeing and local capacity
• Implement a tiered response to maintain access to essential services and quality of care
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Our readiness and response approach
CHQ applies a workstream governance structure to our COVID-19 readiness and response approach, with our tier response plans, found in
appendices 1-4, aligned to the following workstream functions:
TIER 0/TIER 1
Prevent local transmission and
prepare/Limited community transmission
TIER 2
Moderate community
transmission
TIER 3 – 5
Significant community
transmission
Recover and regenerate
Local capacity to supply paediatric
demand Demand Adult demand accelerating,
impacting paediatric supply
Minimal / nil local capacity for
paediatrics
Local capacity to supply
paediatric demand
Access available to local services Access Retrieval capacity may be
restricted
Access to QCH may also be
restricted
Access available to local
services
Local workforce operational Workforce Local workforce may be
redeployed to adult services
Leverage statewide paediatric
capability
Local workforce operational
System conditions:
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Response through our established services
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Surge capacity response during COVID-19 pandemic Refer to local Disruption and Disaster Management Plans (DisMaPs) for detailed local surge capacity
Area Tier 1 Tier 2 Tier 3
IPU Surge Bed capacity
205 247 306
ED Capacity Emergency presentations increase by >10% from BAU activity (~230-280 presentations/day)
Emergency presentations increase by >20% from BAU activity (~280-340 presentations/day)
Emergency presentations increase to >340
presentations/day.
PICU Bed
Capacity
23 36 46
CYMHS Bed Capacity
8BC - 6 8BA - 8
Combined capacity 20 Discharge inpatients as able and safe to do so into outpatient care/telehealth services.
Seek support from community mental health services.
Family Testing Clinics and Screening Points
Family Testing Clinic Capacity
CCHR Family Testing Clinic 6 testing bays, testing ability dependant
on demand and staff availability
Total staff required Clinical staff required: 2-6 dependant on demand
Administration staff required: 1.5-6 dependant on demand
Marshall
1 when required during peak demand
Screening
Points
QCH Screening Points:
1 x Raymond St entrance 1 x Stanley Street entrance
1 x QCH car park entrance
Total staff required Clinical staff required:
7-9 dependant on demand
Security staff:
1 (3) at each screening point
Pressure and isolation room Capacity
Total negative pressure rooms
15 Total number of isolation rooms
10
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Statewide considerations
Inter-hospital transfers
Inter-hospital transfers will be coordinated by Children’s Advice and Transport Coordination Hub (CATCH) for non-critical patients.
Critically ill retrievals and transfers are performed by Children’s Hospital Queensland Retrieval Services (CHQRS), coordinated by CHQRS
Paediatric Medical Coordinator (PMC) via Retrieval Services Queensland (RSQ). Staff will need to remove PPE and decontaminate retrieval
equipment in the designated area at the receiving facility. Security staff will have access to PPE to escort CHQRS teams when required.
Refer to CHQRS and CATCH local disruption and disaster management plans.
Inter-state and international transfers
Where inter-state border closures and restrictions are in place and if an infant or child requires to be treated in a CHQ facility or requires
repatriation home post treatment, local teams will:
• Assist families to gain the correct documentation to clear border checkpoints and/or exemptions when required
• Ensure the Children’s Advice and Transportation Coordination Hub (CATCH) is aware and involved in communication with appropriate
state-wide agencies
• Ensure Children’s Hospital Queensland Retrieval Services (CHQRS) are aware of any state-wide directions
• Contact District Disaster Management Unit (DDMU) for assistance to ensure state-wide considerations are included.
For international travellers, government mandated hotel quarantine may be required. This will be dependent upon the current legislation and
border directions. Cases involving international transfers may require the support of the District Disaster Management Group (DDMG), border
force and/or the National Incident room (NIR) to ensure visa and Australian exemptions are adequate as per the current travel restrictions and
requirements.
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Review and evaluation
A review of a COVID-19 readiness and response will be undertaken, with support and facilitation provided by the Infection Management and
Prevention Service and Infectious Diseases and the Disruption and Disaster Management Unit. A debrief or review process should attempt to
identify the effectiveness of systems, preparedness, operational responses and identify areas which may require improvement.
Where the COVID-19 readiness and response plan has been activated, and there has been changes in infection control management
strategies or an exercise has been conducted, the plan will require review. This analysis may involve input from multiple stakeholder agencies.
The focus is on improvements, systems, processes and human factors not individuals. The review should consider the effectiveness of:
- Prevention: any applicable preventative strategies, alterations to infection control and prevention strategies
- Preparedness: education, training, procedure plans and arrangements.
- Response: notification, communication, command, control, collaboration, specific response strategies.
- Recovery: Recovery arrangements and implemented strategies
Key supporting documents
CHQ-POL-62427 Managing Organisational Disruption
CHQ-PROC-62431 – Disruption and Disaster Management – Assurance
CHQ-PROC-62433 Disruption and Disaster Management – Prevention and Preparedness
CHQ-PROC-62434 Disruption and Disaster Management – Response and Recovery
CHQ-PROC-62430 Health Emergency Operations Centre (HEOC)
CHQ-PROC-62420 Code Brown External Emergency / Disaster
CHQ-PROC-62435 Emergency Management
CHQ-PROC-00107 Patient Flow Escalation Response
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CHQ-PROC - 63110 Standard and Transmission and protective based precautions
CHQ-PROC-63330 Infection control guidelines for management during respiratory pandemic
CHQ-PROC-63210 Admission Screening and Safe Patient Placement
CHQ-PROC- 63505 Hand Hygiene and Bare Below the Elbow
CHQ-PROC-63317 Donning and Doffing of Personal Protective Equipment (PPE)
CHQ-WI-80135 Intubation and ventilatory care of patients with respiratory infections that are (or may) be spread by aerosols.
CHQ-PROC-63002 Infection Control Guidelines for the Management of Coronavirus (MERS, SARS, SARS-CoV-2 or Novel Coronavirus)
CHQ-PROC-63005 Transport of suspected and confirmed (MERS, SARS, SARS-CoV-2 or Novel Coronavirus)
CHQ-GDL—63327 The management of children with COVID-19
CHQ-WI-80135 Paediatric Respiratory Care during the COVID-19 Pandemic for all acute and chronic inpatients with respiratory disease
CHQ-WHSPROC-09 Work Health, Safety and Wellbeing – Work from Home
All COVID-19 related governance documentation, including Divisional and work area specific policies, procedures and work instructions, are
available on the COVID-19 Staff Portal and Governance eCatalogue.
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Appendix 1 Tier 0 Prevent local transmission and prepare
Triggers • The Pandemic is well controlled in Australia, further waves may occur if the virus drifts and/or is re-imported into Australia. Currently there is no community
transmission.
• Reduced presentations of suspected of confirmed pandemic disease, although capacity must me adjusted based on demand.
• Sick Leave continues to impact CHQ due to testing and quarantine requirements.
• Return to Normal functioning whilst following CHO directions. i.e. social distancing.
Tier 0: No community transmission
Leadership and Governance
• Enact workstream
governance structure and PMO
• Weekly Tier Zero update
• Daily tiered huddles
• Daily reporting to SHECC
• Screen all patients, families
and visitors at CHQ facilities and services; with clinical
and security support
Workforce
• All staff to maintain Infection Control Guidelines and
COVID-19 Guidelines
• PPE education and skills
retention workshops as
needed
• Promote seasonal Flu
vaccine programs
• Encourage Work from Home
arrangements where
suitable.
• Enhance existing Staff
Wellbeing Programs
• Engage key stakeholders and external partners to
ensure maintenance BAU
services
• Volunteers engage in low risk
activities
• Visitation and Access during
COVID-19 Pandemic Period
• Monitor feedback
• Utilise MyQCH app for
updates
• Ensure consumer
engagement is sought
Patient and Family
Engagement
Essential Health Services
Emergency Department
• Maintain as BAU (~175+)
• Utilise Orange Zone for
patient presenting with COVID-19/ILI symptoms
• Work with testing clinic to balance demand
Essential Support Services
Testing Clinic
• Clinic establishment: Children’s Centre Health
Research Centre Raymond Terrace
• Adjust capacity based on demand
Outpatients
• Rescheduling or utilising virtual care models where
safe to do so
Inpatients
• Maintain as BAU: 205 Beds + non-booked admissions
• Continue booked surgical admissions
• Follow escalation response procedure to increase capacity.
• Minimise patient movements across QCH
• Use of portable imaging, bed
side Meal Delivery for COVID 19
• Continue HITH
PICU
• Maintain as BAU:
23 Beds + emergency
admissions via CHQ
Retrieval Service and ED
• Continue booked surgical
admissions
• Follow escalation response
procedure to increase
capacity
Management of Supplies
• Daily PPE dashboard
stocktake
• PPE ordering to PAR
• Maintain dashboards for stock usage in dietetics,
pharmaceuticals, CRS, BTS, pathology and contractor
services.
• Follow established Cleaning
Matrix
• Maintain BAU PAR level
Linen Supply Guide
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Statewide Considerations
• Support safe paediatric care
as close to home as possible
• Recognise statewide staff
wellbeing and local capacity
• Implement a tiered response to maintain access to essential services and quality
of care
• BAU utilisation of CATCH
and CHQRS services
Communications
• Regular COVID-19 updates
• Weekly COVID-19 EDMS
updates
• Utilise daily tiered huddles to communicate information, provide updates and discuss
concerns.
• Use of online platforms to
continue meetings
• Communication channels:
o COVID-19 Staff and
Family portals
o Digital and physical
signage
o MyQCH app and
o Social media platforms
Essential Health Services
Mental Health
• Maintain as BAU:
14 inpatient beds
• Utilise community mental
health supports
• Utilise virtual platform
• Utilise the Birdies’ Tree
resources Birdies' Tree
Essential Support Services
Community
• Maintain as BAU
• Maintain essential services
within Child Health Services such as immunisation and feeding support clinics via
face-to-face clinics, limit
consultation times
• Utilise virtual platforms
Decision Support and ICT
• Ensure systems remain
functional during and post
the event
• Establish ICT structures throughout dedicated surge
areas
• Ensure Digital Response
Team is engaged.
• Undertake technical infrastructure assessment to
determine possible Digital infrastructure gaps in surge
areas
• Identify service gaps and
technical risk areas and ensure rectification work is
undertaken where possible
• Ensure Digital Training is
engaged and providing clinical and non-clinical
training to identified staff
• Liaise with business areas to
determine reporting and data
requirements for next stages
• Check current stocks of necessary Digital equipment
and commence ordering of
depleted stock
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Appendix 2 Tier 1 Limited community transmission
Triggers • Paediatric patients and their families present to CHQ Emergency Department and Family Testing clinic suspected or confirmed ILI/COVID-19 symptoms or
high risk travel.
• Demand for paediatric care across CHQ is increasing, CHQ will be able to increase capacity and remain in a business as usual model during this phase.
• Staff sick leave increases above annual averages.
• Community services ability to provide care in BAU geographical areas may be affected due to the demand from other Hospital and Health Services to utilise
space.
• Increased demand for the use of PPE due to state-wide or national directions.
Tier 1: (Mild) Locally acquired cases
Leadership and Governance
Additional to Tier 0:
• Establish IMT
• Activate lead forward HEOC
• Activate COVID-19
Readiness and Response Plan
• Activate local and service
level DisMaPs or services plans
• Implement planning strategies to increase capacity and secure
additional resources
Workforce
Additional to Tier 0:
• Apply CHO directions within
hospital setting
• Enact staff management
plans including sick leave
• Activate absence
management process
• Social distancing
enforcement in tea rooms
and shared spaces
• Limit volunteer service to those impacting service
delivery (wayfinding and
patient / carer orientation)
• Flexible suspension of non-essential meetings and
education programs
• Continue essential education
• Security – review model and
increase support where
required
Essential Health Services Essential Support Services
Emergency Department
Additional to Tier 0:
• Emergency presentations
increase by >10% from BAU activity (~230-280
presentations/day)
• Activate ED DisMaP
Testing Clinic
Additional to Tier 0:
• Increase and /or reallocate
staff to increase capacity
Outpatients
Additional to Tier 0:
• With the support of Communication and
Engagement team service leads/NUMS to support families requiring essential
care at CHQ services
Additional to Tier 0:
• Update information based on CHO Public directions, i.e. visitation guidelines and
PPE requirements
Patient and Family
Engagement
PICU
Additional to Tier 0:
• Activate PICU DisMaP
Inpatients
Additional to Tier 0:
• Activate local DisMaPs for
inpatient units and Operative
and Recovery Services
• Increase HITH capacity
• (~20)
Management of Supplies
Additional to Tier 0:
• Increase PPE stock levels as demand increases, update
dashboard
Decision Support and ICT
Additional to Tier 0:
• Activation of Digital
Response Team
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Statewide Considerations
Additional to Tier 0:
• Continue to provide essential community, outpatient and
inpatient services
• Support statewide capacity building by leveraging
existing models: Clinical Advice and Transport
Coordination (CATCH), Virtual PICU and Ward
Rounding, ECHO
• PICU state-wide virtual ward
and close observation
telehealth model
• Paediatric virtual consultations (inpatient and
outpatient)
• Alternative outreach models
via telehealth
• Paediatric-specific COVID-19
information
• Activate CHQRS and CATCH DisMaPs for
management of children
needing transportation
Communications
Additional to Tier 0:
• Maintain
• Daily COVID-19 updates
• Daily updates of
communication channels:
o COVID-19 staff and family
portals
o Physical and digital
signage
o MyQCH app
o Social media platforms
Essential Health Services
Mental Health
Additional to Tier 0:
• Activate CYMHS service
Plans/ DisMaP
• Maintain
Community
Additional to Tier 0:
• Activate CYCHS DisMaP
• Maintain activity and critical
referrals to essential services
• Consider the need to combine face to face service
as facility space may be impacted by the demands
from another HHSs
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Appendix 3 Tier 2 Moderate community transmission
Triggers • Escalating demand from COVID 19 and non-COVID19 patients with an impact to business as usual activities throughout CHQ services and facilities.
• Staffing sick leave increases, 10- 25%. Staff absenteeism due to childcare responsibilities may impact on staffing availability
• Sustained demand for access to PPE due to public health directions and increased capacity.
Tier 2: Moderate, locally acquired cluster
Leadership and
Governance
Additional to preceding tiers:
• Activate CODE Brown Stand Up
• Continue CHO directed public health measures, surveillance and update specific pathogen requirements for infection control management and prevention
Additional to preceding tiers:
• Maintain updates
• Consider cessation of non-essential family entertainment services i.e. starlight
• Provide virtual distraction and entertainment platforms
Patient and Family Engagement
Workforce
Additional to preceding tiers:
• Suspend all non-essential meeting and training, move to online platforms
• Cease volunteer
engagement
• Access essential meetings via virtual platforms only
Communications
As per preceding tiers:
• Maintain updates
Essential Support
Services
Outpatients
As per preceding tiers:
Maintain
Management of Supplies
As per preceding tiers:
Maintain
Decision Support and ICT
As per preceding tiers:
Activation of Digital
Response Team
Essential Health Services
Emergency Department
Additional to preceding tiers:
• Emergency presentations increase by >20% from BAU activity (~280-340 presentations/day)
Inpatients
Additional to preceding tiers:
• Enact expanded clinical capacity – admit to physical capacity 247 beds
• Increase HITH capacity (~30)
Mental Health
Additional to preceding tiers:
• Enact expanded clinical capacity – admit to physical capacity inpatient capacity 20 beds
Testing Clinic
As per preceding tiers:
Maintain
PICU
Additional to preceding tiers:
• Enact expanded clinical capacity – admit to physical capacity 36 beds
Community
As per preceding tiers:
Maintain
Statewide Considerations
Additional to preceding tiers:
• Respond to demand by increasing PICU and ward capacity for increased statewide flows
• Cohort paediatric care at QCH as appropriate and accessible
• Limit/cease back transfers from HHSs as required
• Increase telehealth utilisation for virtual ward rounds and consultation as required
• Expanded Critical Care and Inpatient capacity for enhanced flows to QCH
• Expanded paediatric
HITH catchment
• Expanded local QCH catchment
• Altered back transfer protocol
• Cease adolescent transitions
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Appendix 4 Tier 3-5 Significant community transmission
Triggers • Sustained escalated and increased demand for paediatric care across CHQ facilities and services.
• Adult services are referring patients to CHQ and may seek assistance and support from CHQ to manger an increasing number paed iatric and young adult
patients.
• Staffing sick leave increases, 25-50%.
• An increasing number of community services will be impacted due to the demand from other Hospital and Health Services to utilise CHQ facilities and
space.
• Increased and sustained demand for access to PPE, consumables and equipment due to capacity demands.
• Capacity reached within CHQ inpatient services.
Tier 3: High locally acquired
Leadership and Governance
Additional to preceding tiers:
• Ensure fatigue management
is considered by HEOC
Workforce
Additional to preceding tiers:
• Recall staff from leave as
appropriate.
• Continue working with contracted services to
increase capacity
Essential Health Services Essential Support Services
As per preceding tiers: Maintain.
Patient and Family
Engagement
Emergency Department
Additional to preceding tiers:
• Emergency presentations increase to >340
presentations/day
Testing Clinic
As per preceding tiers: Maintain
Outpatients
Additional to preceding tiers:
• All appointment to rescheduled, cancelled and
moved to virtual platforms
• Emergency activity only Inpatients
Additional to preceding tiers:
• Enact expanded clinical
capacity – admit to physical
capacity 306 beds.
• Increase HITH capacity (~40)
PICU
Additional to preceding tiers:
• Enact expanded clinical
capacity into PACU – admit
to physical capacity 46 beds
Management of Supplies
Additional to preceding tiers:
• Maintain and increase as per
demand requirements
Communications
As per preceding tiers: Maintain
Decision Support and ICT
As per preceding tiers:
Activation of Digital Response
Team
Mental Health
Additional to preceding tiers:
• Seek support from
community based mental health programs and access
virtual platforms
Community
As per preceding tiers: Maintain
Statewide Considerations
Additional to preceding tiers:
• Respond to demand by
further increasing PICU and ward capacity for statewide
flows.
• Expand age limits to provide
critical and essential care to young adults (in alignment
with existing expertise).
• Expanded age range to
include young adults.
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In the instance where hospital and health services are at capacity and have exceeded their phased planning, the District Disaster Coordination Centre (DDCC) with the support of the DDMG will activate a Tier 4 response engaging the private hospital networks; followed by a Tier 5 response. This will include the activation of the Brisbane Convention Centre field hospital.
Tier 4: Crisis Collaborate with the District Disaster Management Group (DDMG), MNHHS and MSHHS to utilise private hospital space. Emergency activity only.
Tier 5: Extreme Collaborate with DDMG, MNHHS and MSHHS to access and establish paediatric space in designated field hospital/s. Emergency activity only.