Creating Hospital Surge Capacity: Hospital Functions and ... · Creating Hospital Surge Capacity:...

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Creating Hospital Surge Capacity: Hospital Functions and Reallocation of Resources THIRD NATIONAL EMERGENCY MANAGEMENT SUMMIT The Leading Forum on Disaster, Epidemic and Terrorism Planning, Response and Recovery for Healthcare Organizations Renaissance Washington DC Hotel Washington, DC March 4 - 6, 2009

Transcript of Creating Hospital Surge Capacity: Hospital Functions and ... · Creating Hospital Surge Capacity:...

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Creating Hospital Surge Capacity:Hospital Functions and Reallocation of

Resources

THIRD NATIONAL EMERGENCY MANAGEMENT SUMMIT The Leading Forum on Disaster, Epidemic and Terrorism Planning,

Response and Recovery for Healthcare Organizations

Renaissance Washington DC Hotel Washington, DC

March 4 - 6, 2009

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Presentation ObjectivesPresentation Objectives

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Identify hospital functions critical to the maintenance and creation of surge capacityIdentify a potential method for closing gaps in medical surge demandsIdentify a scalable method able to meet the demands of differenttypes of incidents, adaptable to a variety of hospital sizes andconfigurations and consistent with CDC, ASPR, OSHA, CMS and The Joint Commission standards and guidelines

Identify hospital functions critical to the maintenance and creation of surge capacityIdentify a potential method for closing gaps in medical surge demandsIdentify a scalable method able to meet the demands of differenttypes of incidents, adaptable to a variety of hospital sizes andconfigurations and consistent with CDC, ASPR, OSHA, CMS and The Joint Commission standards and guidelines

Presentation Objectives

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IntroductionIntroduction

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Efforts to contain the economic burden of healthcare in the United States have resulted in improved efficiency in hospital operationsIn part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratiosHealthcare systems are now being charged with the task of increasing surge capacity to accommodate an influx of patients requiring triage and emergent care with little or no advance warningThe purpose of the Hospital Emergency Support Functions Project is to identify staff capabilities and capacity available throughout the hospital that might be reassigned to both clinical and non-clinical services

Efforts to contain the economic burden of healthcare in the United States have resulted in improved efficiency in hospital operationsIn part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratiosHealthcare systems are now being charged with the task of increasing surge capacity to accommodate an influx of patients requiring triage and emergent care with little or no advance warningThe purpose of the Hospital Emergency Support Functions Project is to identify staff capabilities and capacity available throughout the hospital that might be reassigned to both clinical and non-clinical services

Introduction

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MandateMandate

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Hospitals have been tasked by federal funding mandates and accreditation (The Joint Commission to the numbers of patients) to increase their in-house bed surge capacity, identify and establish plans for additional “alternate care” sites and facilities

Hospitals have been tasked by federal funding mandates and accreditation (The Joint Commission to the numbers of patients) to increase their in-house bed surge capacity, identify and establish plans for additional “alternate care” sites and facilities

Mandate

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BackgroundBackground

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Large scale disasters such as hurricane Katrina have drawn attention to the need for medical surge capacityIronically, it is this surge capacity that was eliminated in order to maximize efficiencyWithin a hospital environment there are multiple departments with staff that are capable and competent to provide cross coverage to other areas of the hospital where their expertise may be utilized during a large scale surge incident

Large scale disasters such as hurricane Katrina have drawn attention to the need for medical surge capacityIronically, it is this surge capacity that was eliminated in order to maximize efficiencyWithin a hospital environment there are multiple departments with staff that are capable and competent to provide cross coverage to other areas of the hospital where their expertise may be utilized during a large scale surge incident

Background

Photo credit: LSU, Jon Best

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ChallengesChallenges

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Surge needs associated with a pandemic are among the most challenging given that surge capacity would likely be depletedNo clear means have been established to determine staff suitably to care for this increased patient load Need for sustainability of staff for an extended period of time as seen in a pandemic event

Surge needs associated with a pandemic are among the most challenging given that surge capacity would likely be depletedNo clear means have been established to determine staff suitably to care for this increased patient load Need for sustainability of staff for an extended period of time as seen in a pandemic event

Challenges

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To date, plans nationwide have identified volunteerism and emergency credentialing systems as possible solutions to the staffing issue, however, no evidence has been shown that this approach will appropriately address the staffing needs in a large scale surge incidentCommonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacityExternal mechanisms include alternate care sites, patient transfers, volunteerism and special disaster medical assistance teams

To date, plans nationwide have identified volunteerism and emergency credentialing systems as possible solutions to the staffing issue, however, no evidence has been shown that this approach will appropriately address the staffing needs in a large scale surge incidentCommonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacityExternal mechanisms include alternate care sites, patient transfers, volunteerism and special disaster medical assistance teams

Challenges

Emergency Credentialing Program

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AssumptionsAssumptions

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A large-scale surge incident including, but not limited to a pandemic event, will likely dramatically decrease the available workers in all departments of the hospitalDuring a large-scale surge incident certain hospital services will be cancelledDepartments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periodsStaff may be reassigned and function competently within their field of expertise with applicable just-in-time training

A large-scale surge incident including, but not limited to a pandemic event, will likely dramatically decrease the available workers in all departments of the hospitalDuring a large-scale surge incident certain hospital services will be cancelledDepartments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periodsStaff may be reassigned and function competently within their field of expertise with applicable just-in-time training

Assumptions

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External assistance is unlikely to be available to hospitals in national catastrophes such as a pandemicEmployee illness, care for family members, and fear of contracting serious illness may drive hospital absenteeism rates to 40% while need for services may increase well above the normPrudent hospital planning must include internal mechanisms for increasing capacity and maintaining capability

External assistance is unlikely to be available to hospitals in national catastrophes such as a pandemicEmployee illness, care for family members, and fear of contracting serious illness may drive hospital absenteeism rates to 40% while need for services may increase well above the normPrudent hospital planning must include internal mechanisms for increasing capacity and maintaining capability

Assumptions

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ScopeScope

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The Hospital Emergency Support Functions Project will identify personnel capabilities and capacity available throughout the hospital that may be reassigned to both clinical and non-clinical services during an event that causes a surge of patients and/or as a result of diminished personnel capacityWithin each department, staff functions will be identified and categorized in order to create an all-inclusive database This database will be utilized during a large scale surge event to identify staff positions that may be reassigned to support the care of patients and maintain the hospital’s functional capability

The Hospital Emergency Support Functions Project will identify personnel capabilities and capacity available throughout the hospital that may be reassigned to both clinical and non-clinical services during an event that causes a surge of patients and/or as a result of diminished personnel capacityWithin each department, staff functions will be identified and categorized in order to create an all-inclusive database This database will be utilized during a large scale surge event to identify staff positions that may be reassigned to support the care of patients and maintain the hospital’s functional capability

Scope

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HESF CategoriesHESF Categories

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HESF Categories

The Hospital Emergency Support Functions Project identified the following as essential functions of hospitals:– Patient Care– Staff– Facilities– Communications– Safety/Security– Business Continuity

The Hospital Emergency Support Functions Project identified the following as essential functions of hospitals:– Patient Care– Staff– Facilities– Communications– Safety/Security– Business Continuity

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Clinical Services Clinical Support ServicesEmergency Family and Staff SupportNutrition ServicesMortuary ServicesMaintenance, Engineering and EnergyResource Support and Materials ManagementCommunications and Information TechnologyPublic InformationTransportationSafetySecurity Information and PlanningFinanceHuman Resources

Clinical Services Clinical Support ServicesEmergency Family and Staff SupportNutrition ServicesMortuary ServicesMaintenance, Engineering and EnergyResource Support and Materials ManagementCommunications and Information TechnologyPublic InformationTransportationSafetySecurity Information and PlanningFinanceHuman Resources

HESF CategoriesTo fulfill the essential functions of the hospital, 15 “Hospital Emergency Support Functions” (HESFs) were identified as follows:

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Hospital FunctionsHospital Functions

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Hospital Essential Support Functions

Function HESF Number Primary Support

Patient Care

#1 Clinical Services

- Emergency Services - Critical Care - Med/Surg - Labor and Delivery - Maternity - Pediatrics - Psychiatry

- Ambulatory Care - Cardiology - Home Care - Obstetrics and Gynecology - Rehabilitation Services

#2 Clinical

Support Services

- Diagnostic Imaging - Epidemiology - Intravenous Therapy - Laboratory - Pharmacy - Respiratory Therapy

- Cath Lab - Echocardiography - EEG - Endoscopy - Interventional Radiology - Peripheral Vascular Lab - Physical Medicine - Radiation Therapy - Sleep Lab - Wound Care

#3 Emergency Family and Staff Support

- Care Management - Children's Psychiatric Services - Day Care - Pastoral Care - Psychiatry Services - Social Services

- Elder Care Program - Employee Wellness - Outreach Program - Support Services - Wellness Program

#4 Nutrition

- Cafeteria - Food and Nutrition - Kitchen

- Coffee Shop

#5 Mortuary

- Pathology None

Hospital Functions

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Facilities

#6 Maintenance, Engineering,

and Energy

- Biomedical Engineering - Clinical Engineering - Environmental Services - Laundry/Linen Services - Maintenance - Plant Engineering

None

#7 Resource Support and Materials Management

- Central Processing - Finance Department - Human Resources - Material Management - Purchasing - Receiving - Shipping - Stockroom

- Development Office - Foundation - Supply Chain Management

Communi- cations

#8 Communication and

Information Technology

- Clinical Applications - Help Desk - Information Systems - Interpreter Services - Telecommunications

- Call Center - Compliance Hot Line - Copy Center - Library Services - Marketing and

Communication - Marketing and System

Development - Multimedia Services

#9 Public Information

- Employee Relations - Mailroom - Patient Relations - Public Relations

- Information Services - Lobby/Main Desk - Physician Relations

Hospital Functions

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Safety/ Security

#10 Transportation

- Auxillary - Motor Services - Parking Operations - Patient Escort and Distribution

- Garage

#11 Safety

- Risk Management - Occupationsl Medicine - Safety Officer

None

#12 Security

- Protective Services - Security

None

Business Continuity

#13 Information and Planning

- Administration - Budget and Planning - Facilities Planning and Management - Legal and Risk Services

- Community and Gov. Relations - Corporate Compliance - Decision Support - Financial Planning - Plan and Business Development - Strategic Develop. and Marketing

#14Finance

- Accounting - Accounts Payable - Budget and Reimbursement - Credit Union - Finance - Payroll - Worker's Compensation

- Cashiers - Corporate Finance - Fiscal Servives - Grants and Contracts - Patient Financial Services - Reimbursement

Hospital Functions

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Staff

#3 Emergency Staff and Family

Support

- Employee Assistance Program - Employee Wellness

#15 Human Resources

- Float Pool - Hospitalist Service - House Staff Office - Human Resources - Medical Staff Office - Nursing Office - Volunteers

- Student Services

Hospital Functions

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Compatibility ModelCompatibility Model

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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)

HESF Number Function Name Description Primary

DepartmentsSupporting

Departments

HICS Section Chief(s)

HICS Branch

Director(s)

HICS Unit Leader(s)

HESF #1 Clinical Services

Direct patient care: emergency medicine, critical

care, emergency anesthesia/surgery;

ambulatory and specialty care as resources allow

Patient Care Services

Transportation, Social Services, Pastoral Care,

Volunteer Services

Operations Section Chief

Medical Care Branch Director

Inpatient Unit Leader, Outpatient

Unit Leader, Casualty Care Unit

Leader

HESF #2 Clinical Support Services

Laboratory, Radiology, Pharmacy, Respiratory

Care, etc.

Laboratory, Radiology, Pharmacy

Radiation Therapy, Pathology, Medical Education, Anesthesiology, Volunteer Services

Operations Section Chief

Medical Care Branch Director

Clinical Support Services Unit

Leader

HESF #3Emergency Family

and Staff Support

Social work; Pastoral care; Critical Incident Stress

Management; Interpreter Services; day care, elder

care, mental health, temporary sheltering;

distribution of essentail supplies

Pastoral Care, Social Services

Volunteer Services, Human Resources

Logistics Section Chief

Support Branch Director

Familcy Care Unit Leader, Employee Health & WB Unit

Leader,

Compatibility Model

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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)

HESF Number Function Name Description Primary

DepartmentsSupporting

Departments

HICS Section Chief(s)

HICS Branch

Director(s)

HICS Unit Leader(s)

HESF #4 Nutrition Services

Coordinate with materials management to secure bulk food, water and ice; mass

feeding

Food and Nutrition Services

Environmental Services, Volunteer

Services

Logistics Section Chief,

Operations Section Chief

Service Branch Director (Logs), Infrastructure

Branch Director (Ops)

Staff Food & Water Unit Leader (Logs), Food Services Unit

Leader (Ops)

HESF #5 Mortuary Services

Expansion of facilities/capacity;

postmortem examination & identification; tracking and

liaison to families

Pathology

Environmental Services, Hospital volunteer Services, Pastoral Care, Social Services

Operations Section Chief

Medical Care Branch Director

Casualty Care Unit Leader

HESF #6

Maintenance, Engineering

& Energy

Support or restore essential plant operations, back-up

power and water

Plant Engineering, Hospital Maintenance, Facilities Management, Environmental Services

Safety and Security Operations Section Chief

Infrastructure Branch Director

Power/Lighting Unit Leader,

Water/Sewer Unit Leader, HVAC Unit

Leader, Building/Grounds

Damage Unit Leader, Medical

Gasses Unit Leader, Bedical

Devices Unit Leader,

Environmental Svs Unit Leader

HESF #7

Resource Support & Materials Management

Expansion of just-in time inventory; purchasing,

leasing, management of MOUs/MOAs; Coordination

of donations; logistical resource support and

liaisons

Materials Management,

Purchasing

Development Office, Volunteer Services

Logistics Section Chief,

Finance Section Chief

Support Branch Director (Logs)

Supply Unit Leader (Logs), Cost Unit Leader (Finance), Procurement Unit Leader (Finance)

Compatibility Model

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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)

HESF Number Function Name Description Primary

DepartmentsSupporting

Departments

HICS Section Chief(s)

HICS Branch

Director(s)

HICS Unit Leader(s)

HESF #8Communications &

Information Technology

Support or restore information services,

telemedicine, telephonics, paging to support internal

functions and external connectivity; emergency

notification of staff

Information Technology,

Telecommunicat ions

Volunteer Services, Public Relations,

Safety and Security. Medical Records

Logistics Section Chief

Support Branch Director

IT/IS Unit Leader

HESF #9 Public Information Risk communications to staff and public;

Public Relations

OEP, HR, Information and

Planning, Occupational

Health, Safety and Security

Command Staff

Public Information Officer N/A

HESF #10 Transportation

Logistical support for internal and external transport of

patients; delivery of energy and supplies; securing of

transport routes in conjunction with security;

facility evacuation

Transportation Courier, Materials management

Safety and Security Logistics Section Chief

Support Branch Director

Tranportation Unit Leader

HESF #11 Safety

Coordinates comprehensive health and safety program to include hazardous material and waster management. Ensure compliance with local, state and federal

agencies. Ensures staff safety screening to include

PPE, fit testing, etc.

Occupational Medicine

Patient Care Services,

Pharmacy, Facilities Management

Command Staff Safety Officer N/A

Compatibility Model

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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)

HESF Number Function Name Description Primary

DepartmentsSupporting

Departments

HICS Section Chief(s)

HICS Branch

Director(s)

HICS Unit Leader(s)

HESF #12 Security

Provides security resources to support logistical, medical, transportation and security services. Coordinates the

mobilization of law enforcement.

Security

Plant Engineering, Maintenance,

Facilities Management,

Volunteer Services

Operations Section Chief

Security Branch Director

Access Control Unit Leader, Crowd

Control Unit Leader, Traffic

Control Unit Leader, Search

Unit Leader, Law Enforcement Interface Unit

Leader

HESF #13 Information and Planning

Situational awareness; surge enhancements; mobilization,

scaling of response, demobilization; resource

capabilities; coordination with state emergency response

team

Safety and security,

Admitting Office, Incident

Command/EM Manager

OEP Planning Section Chief N/A

Resource Unit Leader,

Documentation Unit Leader, Situation Unit

Leader

HESF #14 Finance

Approval and tracking of expenditures; filing of claims

(insurers, government disaster reimbursement, etc.); emergency payroll

policies

Finance Human Resources, Risk management

Finance/ Adminstration Section Chief

N/ATime, Unit Leader, Compensation/Clai mes Unit Leader

HESF #15 Human Resources

Coordination of alternate/reassigned staff and volunteers; absentee

policies; furloughs; coordination with payroll;

coordination of cross- training; credentials

verification

Human Resources

Finance, Medical Records,

Occupational Health, Housing Office, Facilities

Management

Logistics Section Chief

Support Branch Director

Labor Pool & Credentialing Unit

Leader

Compatibility Model

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An Emergency Response:An Emergency Response: Operational DiagramOperational Diagram

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Operational Diagram

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Policies for ConsiderationPolicies for Consideration

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Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operationsWho coordinates the assessment of staffing needs across all patient care areasIn conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operationsRole of Labor Pool Unit Leader

Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operationsWho coordinates the assessment of staffing needs across all patient care areasIn conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operationsRole of Labor Pool Unit Leader

Policies for Consideration

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Next StepsNext Steps

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Next Steps

Gain approval of the HESF process from:– Legal – Human Resources– Senior Administration– Emergency Management Committee

Collaboration with Human Resources and Hospital Information Technology on the modification of the applicable databases to include assignment of “primary” or “secondary” to each work unit identified in the database Identify appropriate members of HICS/ICS with access to the database

Gain approval of the HESF process from:– Legal – Human Resources– Senior Administration– Emergency Management Committee

Collaboration with Human Resources and Hospital Information Technology on the modification of the applicable databases to include assignment of “primary” or “secondary” to each work unit identified in the database Identify appropriate members of HICS/ICS with access to the database

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Next Steps

Develop and test process by which identification and reassignment tracking will be accomplishedPrepare user’s manual – “Using the HRDB in an Emergency Response”Provide identified members of HICS/ICS with training in the use of the databaseDesign and develop an exercise testing the utility of the database to identify staff for transfer during a medical surge event

Develop and test process by which identification and reassignment tracking will be accomplishedPrepare user’s manual – “Using the HRDB in an Emergency Response”Provide identified members of HICS/ICS with training in the use of the databaseDesign and develop an exercise testing the utility of the database to identify staff for transfer during a medical surge event

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Questions and CommentsQuestions and Comments

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Contact Information

James L. Paturas, CEM, EMTP, CBCP, FACCPDeputy Director(203) 688-3224

[email protected]

Yale New Haven Center for Emergency Preparedness and Disaster Response

1 Church Street, 5th Floor New Haven, CT 06510 www.yalenewhavenhealth.org/emergency

James L. Paturas, CEM, EMTP, CBCP, FACCPDeputy Director(203) 688-3224

[email protected]

Yale New Haven Center for Emergency Preparedness and Disaster Response

1 Church Street, 5th Floor New Haven, CT 06510 www.yalenewhavenhealth.org/emergency