The Hospital Response Real Time Experience at AMCH Sarah Elmendorf, MD Rebecca O’Donnell MT,CIC.
Post on 16-Dec-2015
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IntroductionIntroduction
Hope for the best, plan for the worstHope for the best, plan for the worst Evolving plan, never completed!Evolving plan, never completed! Current approach-not all the answersCurrent approach-not all the answers 4 initial measures 4 initial measures (J healthcare management 2004 49 (40 227-235))(J healthcare management 2004 49 (40 227-235))
– 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 Assess a single patients entry into AMCH systemAMCH system
– Real timeReal time
Identify current strengths and Identify current strengths and weaknessesweaknesses
– Table topTable top
Respond to weaknessesRespond to weaknesses– Additional needs assessment/planning at Additional needs assessment/planning at
department and division leveldepartment and division level
Assess surge capacityAssess surge capacity
Key AssumptionsKey Assumptions
SARS planning applied to Avian Flu SARS planning applied to Avian Flu PreparednessPreparedness
Overall threat is smallOverall threat is small
Science 2004 304:968-969 Science 2004 304:968-969 BUTBUT High case fatality rateHigh case fatality rate Who (5/05): Who (5/05): Avian flu making ominous Avian flu making ominous
changeschanges Potential global health impact could be Potential global health impact could be
catastrophiccatastrophic
ArrivalArrival
ChallengesChallenges Safe entry into Safe entry into
the systemthe system Preparedness for Preparedness for
the unknown the unknown
StrategiesStrategies Education of Education of
triage stafftriage staff Signage Signage
ArrivalArrival
ChallengesChallenges Diagnosis unknownDiagnosis unknown
– Distinguish from Distinguish from other respiratory other respiratory infectionsinfections
Changes in case Changes in case definitionsdefinitions
StrategiesStrategies Respiratory etiquetteRespiratory etiquette Anyone who presents Anyone who presents
with a cough is with a cough is immediately maskedimmediately masked
Triage alertTriage alert Recognize risk Recognize risk
factorsfactors– Travel, exposure to Travel, exposure to
poultry, exposure to poultry, exposure to other casesother cases
ArrivalArrival
ChallengesChallenges Sign Sign
interpretation interpretation
StrategiesStrategies English and English and
Spanish signsSpanish signs Signs with Signs with
pictures- don’t pictures- don’t reinvent, use!reinvent, use!
Are you confident infection is not being spread?
ArrivalArrival
ChallengesChallenges Surge Capacity Surge Capacity
StrategiesStrategies Influx of patients Influx of patients
will require will require regional regional collaboration and collaboration and coordination coordination
Triage Triage
ChallengesChallenges Triage staff Triage staff
unsure of current unsure of current events and case events and case definitionsdefinitions
StrategiesStrategies Communication Communication
– ICP rep on ED QIT ICP rep on ED QIT – IC roundsIC rounds
AlertsAlerts– Central locationCentral location
EducationEducation Test the systemTest the system
TriageTriage
ChallengesChallenges Enforcement of Enforcement of
respiratory etiquetterespiratory etiquette– Legal issuesLegal issues– Security issues Security issues
StrategiesStrategies Segregate patient Segregate patient
from main waiting from main waiting areaarea
Separate waiting Separate waiting areas/family areas/family conference roomconference room
Development of Development of respiratory etiquette respiratory etiquette bagsbags
Are you prepared to enforce policy?
Isolation Isolation
ChallengesChallenges Extended Extended
PrecautionsPrecautions
Visitors and Visitors and FamilyFamily
StrategiesStrategies Contact/Airborne Contact/Airborne
signs for signs for doorframedoorframe
Stickers for chartStickers for chart CommunicationCommunication
– Notify infection Notify infection controlcontrol
Visitor/family Visitor/family screening, PPE, screening, PPE, check in logscheck in logs
Isolation Isolation
ChallengesChallenges Correct use and Correct use and
removal of removal of personal personal protective protective equipment (PPE)equipment (PPE)
Compliance with Compliance with PPEPPE
Availability of PPEAvailability of PPE
StrategiesStrategies Contact /Airborne Contact /Airborne
signsign PPE removal signPPE removal sign PPE observer PPE observer PPE cartPPE cart Education Education
sessionssessions
IsolationIsolation
ChallengesChallenges Disinfection of Disinfection of
environment and environment and equipmentequipment
StrategiesStrategies Dedicate where Dedicate where
possiblepossible Empty room of Empty room of
unnecessary unnecessary suppliessupplies
Disinfect! Disinfect! Disinfect! Disinfect! Disinfect!Disinfect!
Are you prepared for extended precautions?
Patient MovementPatient Movement
ChallengesChallenges Contain diseaseContain disease CommunicationCommunication
StrategiesStrategies Mask patient Mask patient Identify most Identify most
direct routedirect route Security Security
participation and participation and traffic controltraffic control
ICP involvement ICP involvement Use of PPE duringUse of PPE during
transporttransport
CommunicationCommunicationChallengesChallenges Multiple Multiple
disciplinary disciplinary involvement involvement
StrategiesStrategies Prepared policies-Prepared policies-
located on Intranet sitelocated on Intranet site-- NotificationNotification
- Patient placement- Patient placement
- Patient management- Patient management
- Identification of patient- Identification of patient
- Hand hygiene- Hand hygiene
- PPE- PPE
- Environment and equipment - Environment and equipment
disinfectiondisinfection
- Laboratory specimens- Laboratory specimens
- Linen and waste- Linen and waste
- Interdepartmental transfer- Interdepartmental transfer
- Visitors- Visitors
CommunicationCommunication
ChallengesChallenges Internal/External Internal/External
communicationcommunication
Laboratory Laboratory notificationnotification
StrategiesStrategies County County
notification notification Testing the Testing the
system with other system with other communicable communicable diseasesdiseases
Stickers for lab Stickers for lab specimensspecimens
EducationEducation Intranet site Intranet site
Communication Scheme Communication Scheme Internal ED Medical/Nursing Staff
Epidemiology
Medical Director/Administration
Laboratory
Public Relations
County Health Departments
External
Radiology
NYSDOH Regional Epidemiology
NYSDOH Wadsworth Laboratory
Multiple specialties
Pt Care Unit
Communication: a critical but time consuming element
Medical EvaluationMedical Evaluation
ChallengesChallenges Medical staff fit Medical staff fit
testing/complianctesting/compliancee
StrategiesStrategies Powered air Powered air
purifying purifying respirator (PAPR)respirator (PAPR)
Fit testing critical Fit testing critical medical staffmedical staff
All sizes/types of All sizes/types of N-95 respirators N-95 respirators
available on units available on units
Medical EvaluationMedical Evaluation
ChallengesChallenges
Multi-specialty Multi-specialty involvement/ involvement/ educationeducation
Movement of Movement of patientspatients
StrategiesStrategies Emergency Preparedness Emergency Preparedness
Readiness SiteReadiness Site Streamline clinical Streamline clinical
managementmanagement
Maintain precautionsMaintain precautions Intubate/extubate in Intubate/extubate in
negative pressure roomnegative pressure room Limit movement of Limit movement of
patient patient
DiagnosisDiagnosis
ChallengesChallenges What specimens to What specimens to
collect?collect?
Avian flu/other Avian flu/other respiratory infectionsrespiratory infections
StrategiesStrategies Intranet siteIntranet site
– Identify specimens Identify specimens neededneeded
– Current case Current case definition with definition with symptoms/risk symptoms/risk factors/travel factors/travel
Maintaining precautionsMaintaining precautions
TreatmentTreatment
ChallengesChallenges Options limitedOptions limited
StrategiesStrategies Pharmacy Pharmacy
preparednesspreparedness Vaccination campaignVaccination campaign Increased stock of Increased stock of
antiviral medicationantiviral medication Knowledge of most Knowledge of most
current current recommendationsrecommendations
Potential for SurgePotential for Surge
ChallengesChallenges Overwhelming Overwhelming
resources of resources of health care health care system system – PPE PPE – EquipmentEquipment– StaffStaff
StrategiesStrategies Early recognitionEarly recognition Early treatmentEarly treatment Early isolationEarly isolation Stocked PPEStocked PPE Negative Negative
pressure unitspressure units Patient diversionPatient diversion
Potential for SurgePotential for Surge
ChallengesChallenges Overwhelming Overwhelming
resources of resources of health care health care system system – PPE PPE – EquipmentEquipment– StaffStaff
StrategiesStrategies Team approachTeam approach On the spot On the spot
tracking and tracking and references, Palm references, Palm Pilots Pilots
Potential for SurgePotential for Surge
ChallengesChallenges Multiple hospital Multiple hospital
CollaborationCollaboration
StrategiesStrategies Regional Resource Regional Resource
CenterCenter HEOCCHEOCC Albany County Albany County
Community Community Advisory GroupAdvisory Group
Albany County Albany County Communicable Communicable Disease WorkgroupDisease Workgroup
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