the hospital response real time experience at amch hospital response real time experience at amch...
TRANSCRIPT
IntroductionIntroduction
Hope for the best, plan for the worstHope for the best, plan for the worstEvolving plan, never completed!Evolving plan, never completed!Current approachCurrent approach--not all the answersnot all the answers4 initial measures 4 initial measures (J healthcare management 2004 49 (40 227(J healthcare management 2004 49 (40 227--235))235))
–– hospital staff educationhospital staff education–– information technologyinformation technology–– disease surveillance improvementdisease surveillance improvement–– additional equipment and staffadditional equipment and staff
Regional effortsRegional efforts
ApproachApproach
Assess a single patients entry into AMCH Assess a single patients entry into AMCH systemsystem
–– Real timeReal time
Identify current strengths and weaknessesIdentify current strengths and weaknesses–– Table topTable top
Respond to weaknessesRespond to weaknesses–– Additional needs assessment/planning at department Additional needs assessment/planning at department
and division leveland division level
Assess surge capacityAssess surge capacity
Key AssumptionsKey Assumptions
SARS planning applied to Avian Flu SARS planning applied to Avian Flu PreparednessPreparednessOverall threat is smallOverall threat is small
Science 2004 304:968Science 2004 304:968--969 969 BUTBUTHigh case fatality rateHigh case fatality rateWho (5/05): Who (5/05): Avian flu making ominous changesAvian flu making ominous changesPotential global health impact could be Potential global health impact could be catastrophiccatastrophic
ArrivalArrival
ChallengesChallengesSafe entry into the Safe entry into the systemsystemPreparedness for Preparedness for the unknown
StrategiesStrategiesEducation of triage Education of triage staffstaffSignage Signage
the unknown
ArrivalArrival
ChallengesChallengesDiagnosis unknownDiagnosis unknown–– Distinguish from other Distinguish from other
respiratory infectionsrespiratory infections
Changes in case Changes in case definitions
StrategiesStrategiesRespiratory etiquetteRespiratory etiquetteAnyone who presents Anyone who presents with a cough is with a cough is immediately maskedimmediately maskedTriage alertTriage alertRecognize risk factorsRecognize risk factors–– Travel, exposure to Travel, exposure to
poultry, exposure to poultry, exposure to other cases
definitions
other cases
ArrivalArrival
ChallengesChallengesSign interpretation Sign interpretation
StrategiesStrategiesEnglish and Spanish English and Spanish signssignsSigns with picturesSigns with pictures--don’t reinvent, use!don’t reinvent, use!
Are you confident infection is not being spread?
ArrivalArrival
ChallengesChallengesSurge Capacity Surge Capacity
StrategiesStrategiesInflux of patients Influx of patients will require regional will require regional collaboration and collaboration and coordination coordination
Triage Triage
ChallengesChallengesTriage staff unsure Triage staff unsure of current events of current events and case definitionsand case definitions
StrategiesStrategiesCommunication Communication –– ICP rep on ED QIT ICP rep on ED QIT –– IC roundsIC rounds
AlertsAlerts–– Central locationCentral location
EducationEducationTest the systemTest the system
TriageTriage
ChallengesChallengesEnforcement of Enforcement of respiratory etiquetterespiratory etiquette–– Legal issuesLegal issues–– Security issues
StrategiesStrategiesSegregate patient from Segregate patient from main waiting areamain waiting areaSeparate waiting Separate waiting areas/family areas/family conference roomconference roomDevelopment of Development of respiratory etiquette respiratory etiquette bags
Security issues
bags
Are you prepared to enforce policy?
Isolation Isolation
ChallengesChallengesExtended Extended PrecautionsPrecautions
Visitors and FamilyVisitors and Family
StrategiesStrategiesContact/Airborne Contact/Airborne signs for doorframesigns for doorframeStickers for chartStickers for chartCommunicationCommunication–– Notify infection Notify infection
controlcontrol
Visitor/family Visitor/family screening, PPE, screening, PPE, check in logscheck in logs
Isolation Isolation
ChallengesChallengesCorrect use and Correct use and removal of personal removal of personal protective protective equipment (PPE)equipment (PPE)Compliance with Compliance with PPEPPEAvailability of PPEAvailability of PPE
StrategiesStrategiesContact /Airborne Contact /Airborne signsignPPE removal signPPE removal signPPE observer PPE observer PPE cartPPE cartEducation sessionsEducation sessions
IsolationIsolation
ChallengesChallengesDisinfection of Disinfection of environment and environment and equipment
StrategiesStrategiesDedicate where Dedicate where possiblepossibleEmpty room of Empty room of unnecessary unnecessary suppliessuppliesDisinfect! Disinfect! Disinfect! Disinfect! Disinfect!
equipment
Disinfect!
Are you prepared for extended precautions?
Patient MovementPatient Movement
ChallengesChallengesContain diseaseContain diseaseCommunication
StrategiesStrategiesMask patient Mask patient Identify most direct Identify most direct routerouteSecurity Security participation and participation and traffic controltraffic controlICP involvement ICP involvement Use of PPE duringUse of PPE duringtransport
Communication
transport
CommunicationCommunicationChallengesChallenges
Multiple disciplinary Multiple disciplinary involvement
StrategiesStrategiesPrepared policiesPrepared policies--located on Intranet sitelocated on Intranet site-- NotificationNotification-- Patient placementPatient placement-- Patient managementPatient management-- Identification of patientIdentification of patient-- Hand hygieneHand hygiene-- PPEPPE-- Environment and equipment Environment and equipment
disinfectiondisinfection-- Laboratory specimensLaboratory specimens-- Linen and wasteLinen and waste-- Interdepartmental transferInterdepartmental transfer-- Visitors
involvement
Visitors
CommunicationCommunication
ChallengesChallengesInternal/External Internal/External communicationcommunication
Laboratory Laboratory notification
StrategiesStrategiesCounty notification County notification Testing the system Testing the system with other with other communicable communicable diseasesdiseases
Stickers for lab Stickers for lab specimensspecimensEducationEducationIntranet site
notification
Intranet site
Communication Scheme Communication Scheme EDInternal Medical/Nursing Staff
Epidemiology
Laboratory
Public Relations
County Health Departments
Radiology
NYSDOH Regional Epidemiology
NYSDOH Wadsworth Laboratory
Pt Care Unit
Medical Director/Administration Multiple
specialties
External
Communication: a critical but time consuming element
Medical EvaluationMedical Evaluation
ChallengesChallengesMedical staff fit Medical staff fit testing/compliancetesting/compliance
StrategiesStrategiesPowered air Powered air purifying respirator purifying respirator (PAPR)(PAPR)Fit testing critical Fit testing critical medical staffmedical staffAll sizes/types of All sizes/types of NN--95 respirators 95 respirators available on units available on units
Medical EvaluationMedical Evaluation
ChallengesChallenges
MultiMulti--specialty specialty involvement/ educationinvolvement/ education
Movement of patientsMovement of patients
StrategiesStrategiesEmergency Preparedness Emergency Preparedness Readiness SiteReadiness SiteStreamline clinical Streamline clinical managementmanagement
Maintain precautionsMaintain precautionsIntubate/extubate in Intubate/extubate in negative pressure roomnegative pressure roomLimit movement of patient Limit movement of patient
DiagnosisDiagnosis
ChallengesChallengesWhat specimens to What specimens to collect?collect?
Avian flu/other Avian flu/other respiratory infectionsrespiratory infections
StrategiesStrategiesIntranet siteIntranet site–– Identify specimens Identify specimens
neededneeded–– Current case definition Current case definition
with symptoms/risk with symptoms/risk factors/travel factors/travel
Maintaining precautionsMaintaining precautions
TreatmentTreatment
ChallengesChallengesOptions limited
StrategiesStrategiesPharmacy preparednessPharmacy preparednessVaccination campaignVaccination campaignIncreased stock of Increased stock of antiviral medicationantiviral medicationKnowledge of most Knowledge of most current current recommendations
Options limited
recommendations
Potential for SurgePotential for Surge
ChallengesChallengesOverwhelming Overwhelming resources of health resources of health care system care system –– PPE PPE –– EquipmentEquipment–– Staff
StrategiesStrategiesEarly recognitionEarly recognitionEarly treatmentEarly treatmentEarly isolationEarly isolationStocked PPEStocked PPENegative pressure Negative pressure unitsunitsPatient diversion
Staff
Patient diversion
Potential for SurgePotential for Surge
ChallengesChallengesOverwhelming Overwhelming resources of health resources of health care system care system –– PPE PPE –– EquipmentEquipment–– Staff
StrategiesStrategiesTeam approachTeam approachOn the spot On the spot tracking and tracking and references, Palm references, Palm Pilots Pilots
Staff
Potential for SurgePotential for Surge
ChallengesChallengesMultiple hospital Multiple hospital Collaboration
StrategiesStrategiesRegional Resource Regional Resource CenterCenterHEOCCHEOCCAlbany County Albany County Community Advisory Community Advisory GroupGroupAlbany County Albany County Communicable Disease Communicable Disease Workgroup
Collaboration
Workgroup