Ability to Respond by Ability to Respond by Health Services Plan Health Services Plan before an eventual before an eventual Pandemic Pandemic CHILE MINISTRY OF HEALTH Dr María Brito April 2006
Dec 31, 2015
Ability to Respond by Health Ability to Respond by Health Services Plan before an Services Plan before an
eventual Pandemiceventual Pandemic
CHILE MINISTRY OF HEALTH
Dr María Brito
April 2006
Components Considered in the PlanComponents Considered in the Plan
1.- Organization:
• Organizational Chart• Flows and Coordination Systems• Parties Responsible• Incorporation of other Players
2.- Functions:
• Definition of the functions of each one of the actors during the different Phases of the Pandemic
I.- Organization and Functioning
EMERGENCY COMMITTEEEMERGENCY COMMITTEE
Public HealthSub Secretary
NetworkSub Secretary
Communications Legal
DPI DIGERA
Sanitary Coordination in PandemicNorth
Sanitary Coordination in Pandemic South
Sanitary Coordination in PandemicCenter
RRHH
Components Considered in the PlanComponents Considered in the Plan
1.- Outpatient Care
II.- Installed Capacity, Assignment of Resources:
•Number of establishments
•Assignment of available Human Resources
•Social, private organizations etc.
•Availability of :
•Drugs
•Supplies
•Equipment
Components Considered in the PlanComponents Considered in the Plan
2.- Hospital Care
II.- Installed Capacity, Assignment of Resources:
•Number of establishments (public and private)•Number of total beds available (public and private)•Number of critical beds available (public and private)•Availability of equipment to support critical activity•Availability of RRHH to support critical activity•Hospital management indicators•Availability of:
DrugsSuppliesEquipment
Components considered within the en el Components considered within the en el PlanPlan
1.- Outpatient Care
• Out fitting of additional services• Availability of extra RRHH
2.- Hospital Attention
• Number of possible beds to reconvert
• RRHH that supports the increase in activity
• Installed physical capacity that allows an increase of beds
• Ability to establish strategic reserves (storage and distribution)
II.- Potential Capacity
Theoretical Impact StudyTheoretical Impact Study
General Assumptions
• Attack Rate • Population to be considered• Lethality • Corresponding periods and percentages
(consultations and/or hospitalization)
Assumptions Outpatient Care
• Percentage of consultations to be carried out• Number of consultations per patient• Output of consultations per hour
III.- Establish the assumptions
Theoretical Impact ExerciseTheoretical Impact Exercise
3.- Hospital Care Assumptions
• Hospitalization percentages according to groups• Average length of stay of patients in critical beds• Percentage of patients in critical beds• Percentage of less complex hospitalizations
III.- Establish the Assumptions
Bed requirementsBed requirements
88% of beds requested are for Special Care
• 12% of required beds are for Critical Care.
SCU88%
ICU6%
UTI6%
• Of the total critical beds 50% correspond to intensive care beds (Mechanical Ventilator and Invasive Monitoring)
Example….Example….
ATTACK RATE 20%TOTAL CHILDREN ADULTS
COUNTRY TOTAL 15,116,435 3,890,126 11,226,309
NUMBER OF CASES 3,023,287 778,025 2,245,262
HOSPITALIZATIONS 0.5% (<65) y 1% (>65) 16,334 3,890 12,444
REQUIRED BEDS 4,840 1,153 3,687
MORTALITY 1%(<65) y 30% (>65) 870 39 831
ATTACK RATE 40% TOTAL CHILDREN 15-64 YEARS
TOTAL COUNTRY 15,116,435 3,890,126 11,226,309
NUMBER OF CASES 6,046,574 1,556,050 4,490,524
HOSPITALIZATIONS 0.5% (<65) y 1% (>65) 32,667 7,780 24,887
REQUIRED BEDS 9,679 2,305 7,374
MORTALITY 1%(<65) y 30% (>65) 1,739 78 1,661
General Results of the Exercise
Components Considered in the PlanComponents Considered in the Plan
1.- Outpatient Care
• RRHH Gap• Gap supplies, medicine and equipment• Valuation of the estimated Gaps
2.- Hospital Care
Gap RRHHGap supplies and reactiveGaps medicineGap in equipment that provides critical activity supportValuation of the Gaps
IV.- Gap Analysis
Total hired Hours
Total hired hours
Total consulations to carry out
1° Pick of consulations
with an attack rate
of 20%
Number of patients per
hour(10) Gap in hours
2° Pick of consultation
s with an attack reate
of 20%
Number of patients per
hour(10)
Gap in hours measured
con 20% funcionarios
enfermos
50% del Total
70% de consultas
horas requeridas
no hay brecha
30% de consultas
horas requeridas
no hay brecha
401.812 321.450 1,511,644 1,058,150 105,815 215,635 453,493 45,349 276,100
REQUIMENT OF MEDICAL HOURS FOR OUTPATIENT CARE RATE 20% Attack Rate 20% Total Country
Estimate of the Gaps in Outpatient CareEstimate of the Gaps in Outpatient Care
Estimate of Gaps in Hospital Care (Beds)Estimate of Gaps in Hospital Care (Beds)
Children Adults
Children Adults Children Adults Children Adults
1,014 3,245 146 468 148 128 2- 351-
2,006 6,416 300 959 148 128 151- 830-
Total Critical Beds Required (12%)
Total Number of Beds Required in Special Care
(88%)
Adjusted offer of Critical Beds
Gap in critical beds according to attack rate
•Special care beds were counted as new
• For the gap in critical beds, a real availability of adult critical beds of 10%, and 30% for pediatric was considered.
In conclusionIn conclusion
• Information must be available
• Information must be analyzed
• Indicators about the management of beds must be included as part of the analysis process
• Expert consensus is required
Components to be implementedComponents to be implemented
• Make the Health Services and Establishment’s Plan operational.
• Responsibly design the carrying out of preparatory exercises for a Pandemic at the local level
• Simulation exercises
• Inform authorities about the required adjustments for the implementation of the plan
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