The Story of the Toronto Central Local Integrated Network
2010 G20 DashboardWhy we should look at it Again
Laurie Mazurik MD FRCPC MBA
Project Lead, Pandemic Orange
Special Acknowledgement
http://www.torontocentrallhin.on.ca/
In 2010 TCLHIN went to extraordinary lengths to support theirStakeholders as they prepared for very real threats to their ability to deliver patient care during the 2010 G20 Summit.
The journey was a fascinating exploration of relationships and innovative thinking. All those involved applaud their initiative and leadership.
Laurie Mazurik MD (The Story Teller)
• Specialist in Emergency Medicine, Sunnybrook Hospital, Toronto
• Critical Care Transport Physician (Air and Land)• Strategic Lead, Disaster and Emergency
Preparedness Sunnybrook• Member of Ontario SARS Operation Centre 2003• Conducted over 40 mass casualty health care system simulations since 2003
• TCLHIN Lead for 2010 G20 Summit Preparations
Why worry.
There is lots of money to prepare
1 billion dollars for security (prevention)
~Almost 0$ for health care. It’s a good “learning” opportunity
We learned
• What a HIRA is. Do you know?• That Security/Police thought the best place to
hold protest marches is as close to 6 major Toronto hospitals as possible (They were the usual Protest Areas)
• How to CUUS and SBAR
• That Information is the new gold
Queens Park
PMHTGH
TWH
Legal Protest SiteDundas Square
Legal Protest Site Nathan Philips
Square Legal Protest Site Queen’s Park - South
SMH
Security Planning
Zone 1(Red or Summit Site)
Zone 2(Yellow or Outer Zone)
Limited-access area surrounding summit site
No hospital in the Red or Yellow zone Perimeter fencing
Zone 3(Community)
MSH
We learned what a HIRA was
ThreatsScenario Likelihood Impact to
Hospitals
Heat wave/ Power outage
low high
Mass casualty event – Code Orange
low high
Unlawful protest with use of irritant gases
moderate high
Transportation interruptions
high moderate
Lots of hints about concerns
International Politics Lingering Worry
http://goo.gl/xTsLvP
We Did become Worried
Overcrowded ED’s
Let’s Think SMART
We just need Information IMS…no so effective
• We are not like police or military who use a hierarchal system daily
• We think triage, capacity and patient flow
• We can live with “liaison” and “in-charge”
1212
A Dashboard with SIX sources of Information
Toronto EMS:Riot at Queen’s Park Protest. Tear Gas Used. Some people may have serious injuries from falls.
Health Network:Code Orange:HSC, Sinai: TGH: Clinics: OpenCCAC:Delay 6hr
ALERTS
Media:1000’s riot Ministry of Health Bulletins
Contact Lists
Speak in SBAR,CUUS and Capacity
13
Consistent and Easy to Use
SBAR: Acronym
• S=situation: Briefly describe the current situation.
• B=background: State the pertinent history.• A=assessment: Summarize the facts and
what you think the problem is• R=recommendation: What you think needs to
be done in order to be address the problem safely and effectively
Situation
• In critical events it is very difficult to get timely,credible information
• It is disparate
• Incomplete
Background
• There 3 main sources of information• Media = fast not always credible• EMS =relatively fast, credible, does not
include ambulatory surge• Phone who you know= piece meal, usually
they don’t know either
Assessment
• If a critical incident occurs we will have a delayed indecisive and response
• Will not be able to provide EMS with credible information to justify diversion of selected ambulances away from hospitals
Recommendation
• Capture and Share Credible information in real-time
• Work with EMS to distribute surges across ALL health care resources
• Preserve Acute Care CRITICAL Services that other hospitals do not have
Talk about Capacity and set thresholds for Alerts
• N= normal capacity =Green• 10-20% over N= YellowYellow• >20% = Red• Overwhelmed• Unable to Provide Service
Critical Language used:CUUS
• Key Phrases must be understood by ALL to mean “STOP and Listen”-we have a potential problem
• Example: United Airlines “CUUS” Program
I am Concerned I am Uncomfortable This is Unsafe I am Scared
TC LHIN Background
Submit Situational Report
Overall Capacity ED Trauma Critical
Care STEMI Acute Stroke Neurosurgery Dialysis Labour &
Delivery Paediatrics
SHSC NA NA
Mount Sinai Hospital
NA NA
Toronto General
NA NA NA NA
TEGH NA NA NA NA
St. Michael’s
Walk-in only
St. Joseph’s Health Centre
NA NA NA NA
Hospital for Sick Children
NANA
Women’s College Hospital
NANA NA NA NA NA NA
TC LHIN Background
Submit Situational Report
Overall Cap
ED TraumaCritical Care
STEMIAcute Stroke
Neurosurg DialysisLabour
& Delivery
Paediatrics
SHSC NA NA
Mount Sinai Hospital
NA
Toronto General
NA NA NA NA
TEGH NA NA NA NA
St. Michael’s
St. Joseph’s Health Centre
NA NA NA NA
Hospital for Sick Children
NANA
Women’s College Hospital
NANA NA NA NA NA NICU
Triggers Telco between TCLHIN Leads,Hospital Leads, TEMS,CritiCall,ORNGE & MOH
We Build “Smart System”
• Based it on Media Display Systems
• Used Terminology we could understand
• Defined the Data we wanted in real-time
• The way in which we wanted it reported and displayed
• Set thresholds for Alerts or Alarms
• Approached the TCLHIN to help us
The G20 Dashboard
Build Capacity Based Action Plans
Hospitals
How did it perform?• Hospital security
provided info faster than media or police
• Coordinated diversion of ambulances to “open” hospitals
• Everyone understood the plan
Now We want to Build a New Prototype with End-user Input
Giving Health Care Providers a chance to capture data and exchange ideas across a
greater network
Hospitals
Add or track internal Hospital Dashboards
Unit Staff Beds Pharm Supplies Other Status
ED
Trauma
Critical Care
OR
ALERTS
Integrated Syndromic Surveillance
MASAS Multi-Agency Situational Awareness System
Increase portability with Tablet and Smart Phone formats
Value
• Track trends
• Look at Consequences
• Identify Predictable Patterns
• Build Strategies to Mitigate
• Examine what others do in a broader network
• Build/Test Models
Next Steps: Engagement
Join The CBRNE Collaborative
Time Limited Offer
• Explore the actual G20 Dashboard and give us feedback
• Do the polls in our e-learning modules and join some discussions
• Share your ideas and lets grow them together.