1 Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only April 10, 2020 | Suzanne Weiss, Cindy Nordstrom, Megan Glenn Ambulatory Nursing Surge Staffing Plan Created by Megan Glenn, Cindy Nordstrom, Sue Weiss| Created 4/10/2020 | Approved by Sharon Quinlan
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1Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
April 10, 2020 | Suzanne Weiss, Cindy Nordstrom, Megan Glenn
Ambulatory Nursing Surge Staffing Plan
Created by Megan Glenn, Cindy Nordstrom, Sue Weiss| Created 4/10/2020 | Approved by Sharon Quinlan
2Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Objectives
• Understanding Duty to Care and need for surge staffing
• Identify strategies to continue providing safe patient care with Lean staff
• Apply considerations for redeployment
• Completion/Utilization of Reassignment Spreadsheet
• Understanding of Surge Orientation Support Training (S.O.S.)
• Identify Steps for Call to Action
• Review Available Resources
3Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Duty to CareEthical responsibility during a pandemic
Assume new responsibilities
4Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Ambulatory Nursing Surge Staffing
Surge Level 1Internal surge management
Identify, redeploy and train clinic staff to support Clinical Contact Centers:• Triage trained or triage-ready RNs that have been identified by clinic leadership for deployment to the
Contact Centers – in process • Utilize furloughed and zero hour nurses who are triage trained or triage-ready • Secure contingent labor - Gary Weller, Contingent Labor Director has potential sources• Daytime support to CCCS by in-clinic nurses as time allows - minimizes disruption to clinic ops• Recruit trained nurses for extra shifts.
Surge Level 2Identify non-
essential RNs for deployment to inpatient care
Deploy non-essential and furloughed RNs to support inpatient care demands• Identify furloughed RNs for deployment to inpatient care
• Identify essential/non-essential RNs for deployment to inpatient care• Identify RNs with risk factors precluding direct care – deploy to other areas of need
Surge Level 3Critical inpatient
RN needs
Deploy ambulatory nurses to meet critical inpatient care needs by prioritizing essential RN duties to free up more RNs for inpatient care• Essential/Non-essential RN duties (see appendix)• Centralization and consolidation of services• Reduction in frequency of routine follow-up and monitoring • Reorganization of RN activities to other people
5Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Guiding Principles for Surge Staffing• Remain at Pandemic Level 3 and not advance to Pandemic Level 4
• Critically evaluate staffing needs at the clinic level
• Identify and prepare team members for redeployment
• Guide for use – may not be all inclusive
6Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Strategies for Safe Patient Care
7Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Essential Duties
RN LPN/MAAnticoagulation Immunizations
Urgent Care Staffing Other injections in face-to-face visits
TCM Calls Prescription Refills
Follow-up w/High Risk Population Rooming for face-to-face visits
Holter/Pacemaker Checks Support core clinic functions
Urgent/Emergent Procedure Support
Cancer Infusion
Triage
8Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Non-Essential RN DutiesRe-assign Duty To:
Re-scheduling/cancelling of special procedures PSR or MA
Medication Management• Med titration
Physician/APC
Medication Administration• Depo-provera
MA w/physician/APC
Medication Refills MA w/physician/APC support
Forms• Work excuse• FMLA• Prior authorization
MA w/physician/APC support
Annual Medicare Wellness Visits Delay scheduling
9Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Possible “Lean” solutions
• Regionalize resources
o One specialty/primary care RN covers for a group of clinics
• Supervisors and Lead RNs replace RNs
o Evaluate impact on other leadership responsibilities
• Virtual care framework reduces RN workload demands
o More efficient to have clinician handle the visit comprehensively
• Consider moving triage to the clinical contact center (in WI)
• Move TCM and other high risk population calls to Enterprise Population Health
• Consider reduction in frequency of device checks for stable population
• Transfer diabetes education to endocrinology department
10Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Possible “Lean” Solutions (cont)• Consolidate clinical services to consolidate staffing
• Transfer LPN duties to MAs
• Hold on non-essential work
• Paperwork (i.e. handicap sticker, school forms, etc.)
• Routine labs delayed
• Rooming process completed by provider during virtual visits (may be more
efficient by preventing transferring patient)
• For MAs who are cross-trained, assume PSR/MA role to free PSR
• Hold on non-essential services, e.g. school forms, handicap parking, non-
urgent routine lab orders
11Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
Identifying Team Members for Reassignment
Wisconsin
Accountable Leader: Sr Director Administrator or Designee
1. Identify leader for Ambulatory Site Labor Command role (WI)/geographic region
Plan to implement SOS training Plan to implement SOS training
Communicate reassignment plan with physicians/APCs and team members
Communicate reassignment plan with physicians/APCs and team members
24Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only
RESOURCESCOVID 19 Information Center
• Team member resources• PPE• SOS training• Ambulatory Nursing Surge Staffing Plan webinar & presentation• Duty to Care• Human Resources COVID-19 Pay Practices
Tip sheet for Populating the Reassignment Spreadsheet