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Transcript of 1 Creating Hospital Surge Capacity: Hospital Functions and Reallocation of Resources THIRD NATIONAL...
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Creating Hospital Surge Capacity:Hospital Functions and Reallocation of
Resources
THIRD NATIONAL EMERGENCY MANAGEMENT SUMMITThe Leading Forum on Disaster, Epidemic and Terrorism Planning,
Response and Recovery for Healthcare Organizations
Renaissance Washington DC HotelWashington, DC
March 4 - 6, 2009
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Identify hospital functions critical to the maintenance and creation of surge capacity
Identify a potential method for closing gaps in medical surge demands
Identify a scalable method able to meet the demands of different types of incidents, adaptable to a variety of hospital sizes and configurations 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 capacity
Identify a potential method for closing gaps in medical surge demands
Identify a scalable method able to meet the demands of different types of incidents, adaptable to a variety of hospital sizes and configurations and consistent with CDC, ASPR, OSHA, CMS and The Joint Commission standards and guidelines
Presentation Objectives
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Efforts to contain the economic burden of healthcare in the United States have resulted in improved efficiency in hospital operations
In part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratios
Healthcare 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 warning
The 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 operations
In part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratios
Healthcare 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 warning
The 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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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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Large scale disasters such as hurricane Katrina have drawn attention to the need for medical surge capacity
Ironically, it is this surge capacity that was eliminated in order to maximize efficiency
Within 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 capacity
Ironically, it is this surge capacity that was eliminated in order to maximize efficiency
Within 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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Surge needs associated with a pandemic are among the most challenging given that surge capacity would likely be depleted
No 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 depleted
No 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 incident
Commonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacity
External 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 incident
Commonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacity
External mechanisms include alternate care sites, patient transfers, volunteerism and special disaster medical assistance teams
Challenges
Emergency Credentialing Program
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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 hospital
During a large-scale surge incident certain hospital services will be cancelled
Departments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periods
Staff 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 hospital
During a large-scale surge incident certain hospital services will be cancelled
Departments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periods
Staff 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 pandemic
Employee 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 norm
Prudent 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 pandemic
Employee 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 norm
Prudent hospital planning must include internal mechanisms for increasing capacity and maintaining capability
Assumptions
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80
100
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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 capacity
Within 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 capacity
Within 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 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 Services Emergency Family and Staff Support Nutrition Services Mortuary Services Maintenance, Engineering and Energy Resource Support and Materials Management Communications and Information Technology Public Information Transportation Safety Security Information and Planning Finance Human Resources
Clinical Services Clinical Support Services Emergency Family and Staff Support Nutrition Services Mortuary Services Maintenance, Engineering and Energy Resource Support and Materials Management Communications and Information Technology Public Information Transportation Safety Security Information and Planning Finance Human 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 Essential Support Functions
Function HESF Number Primary Support
PatientCare
#1ClinicalServices
- Emergency Services - Critical Care - Med/Surg - Labor and Delivery - Maternity - Pediatrics - Psychiatry
- Ambulatory Care - Cardiology - Home Care - Obstetrics and Gynecology - Rehabilitation Services
#2Clinical
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
#3Emergency 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
#4Nutrition
- Cafeteria - Food and Nutrition - Kitchen
- Coffee Shop
#5Mortuary
- Pathology None
Hospital Functions
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Facilities
#6Maintenance, Engineering,
and Energy
- Biomedical Engineering - Clinical Engineering - Environmental Services - Laundry/Linen Services - Maintenance - Plant Engineering
None
#7Resource Support and Materials Management
- Central Processing - Finance Department - Human Resources - Material Management - Purchasing - Receiving - Shipping - Stockroom
- Development Office - Foundation - Supply Chain Management
Communi-cations
#8Communication 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
#9Public Information
- Employee Relations - Mailroom - Patient Relations - Public Relations
- Information Services - Lobby/Main Desk - Physician Relations
Hospital Functions
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Safety/Security
#10Transportation
- Auxillary - Motor Services - Parking Operations - Patient Escort and Distribution
- Garage
#11Safety
- Risk Management - Occupationsl Medicine - Safety Officer
None
#12Security
- Protective Services - Security
None
Business Continuity
#13Information 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
#3Emergency Staff and Family
Support
- Employee Assistance Program
- Employee Wellness
#15Human Resources
- Float Pool - Hospitalist Service - House Staff Office - Human Resources - Medical Staff Office - Nursing Office - Volunteers
- Student Services
Hospital Functions
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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)
HESF Number
Function Name DescriptionPrimary
DepartmentsSupporting
Departments
HICSSection 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 #2Clinical 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 DescriptionPrimary
DepartmentsSupporting
Departments
HICSSection 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 #6Maintenance, Engineering
& Energy
Support or restore essential plant operations, back-up
power and water
Plant Engineering, Hospital Maintenance, Facilities Management, Environmental Services
Safety and SecurityOperations
Section ChiefInfrastructure
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 #7Resource 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 DescriptionPrimary
DepartmentsSupporting
Departments
HICSSection 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,
Telecommunications
Volunteer Services, Public Relations,
Safety and Security. Medical Records
Logistics Section Chief
Support Branch Director
IT/IS Unit Leader
HESF #9 Public InformationRisk 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 SecurityLogistics
Section ChiefSupport Branch
DirectorTranportation 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 DescriptionPrimary
DepartmentsSupporting
Departments
HICSSection 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
OEPPlanning
Section ChiefN/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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Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operations
Who coordinates the assessment of staffing needs across all patient care areas
In conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operations
Role of Labor Pool Unit Leader
Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operations
Who coordinates the assessment of staffing needs across all patient care areas
In conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operations
Role of Labor Pool Unit Leader
Policies for Consideration
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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 accomplished
Prepare user’s manual – “Using the HRDB in an Emergency Response”
Provide identified members of HICS/ICS with training in the use of the database
Design 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 accomplished
Prepare user’s manual – “Using the HRDB in an Emergency Response”
Provide identified members of HICS/ICS with training in the use of the database
Design and develop an exercise testing the utility of the database to identify staff for transfer during a medical surge event
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Contact Information
James L. Paturas, CEM, EMTP, CBCP, FACCP
Deputy Director
(203) 688-3224
Yale New Haven Center for Emergency Preparedness and Disaster Response
1 Church Street, 5th Floor New Haven, CT 06510www.yalenewhavenhealth.org/emergency
James L. Paturas, CEM, EMTP, CBCP, FACCP
Deputy Director
(203) 688-3224
Yale New Haven Center for Emergency Preparedness and Disaster Response
1 Church Street, 5th Floor New Haven, CT 06510www.yalenewhavenhealth.org/emergency